Yonsa (abiraterone acetate micronized) — Highmark
metastatic castration-resistant prostate cancer (ICD-10: C61)
Preferred products
- abiraterone acetate 250 mg tablets
- Abirtega
Initial criteria
- age ≥ 18 years
- Diagnosis of metastatic castration-resistant prostate cancer (ICD-10: C61)
- Use in combination with methylprednisolone
- Used in combination with a GnRH analog OR member has had a bilateral orchiectomy
- Member has experienced therapeutic failure or intolerance to one of: abiraterone acetate 250 mg tablets OR Abirtega
Reauthorization criteria
- Prescriber attests member is tolerating therapy and has experienced disease improvement OR delayed disease progression
- Member has experienced therapeutic failure or intolerance to abiraterone acetate 250 mg tablets OR Abirtega
Approval duration
12 months