enzalutamide — United Healthcare
prostate cancer
Preferred products
- Lupron (leuprolide)
- Zoladex (goserelin)
- Trelstar (triptorelin)
- Vantas (histrelin)
- Firmagon (degarelix)
Initial criteria
- Diagnosis of prostate cancer
- AND one of the following:
- (a) BOTH of the following: Disease is castration-resistant AND ONE of the following: Used in combination with a gonadotropin-releasing hormone (GnRH) analog [e.g., Lupron (leuprolide), Zoladex (goserelin), Trelstar (triptorelin), Vantas (histrelin), Firmagon (degarelix)] OR Patient has had bilateral orchiectomy
- OR (b) BOTH of the following: Disease is metastatic castration-sensitive AND ONE of the following: Used in combination with a gonadotropin-releasing hormone (GnRH) analog [e.g., Lupron (leuprolide), Zoladex (goserelin), Trelstar (triptorelin), Vantas (histrelin), Firmagon (degarelix)] OR Patient has had bilateral orchiectomy
- OR (c) Disease is non-metastatic castration-sensitive with biochemical recurrence at high risk for metastasis
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Xtandi therapy
Approval duration
12 months