Orgovyx (relugolix) — United Healthcare

Initial criteria

• Patient is less than 19 years of age OR Diagnosis of advanced prostate cancer OR Drug is recognized for treatment of the cancer indication by NCCN Drugs and Biologics Compendium with Category of Evidence and Consensus of 1, 2A, or 2B

Reauthorization criteria

• Patient does not show evidence of progressive disease while on Orgovyx therapy

Approval duration

12 months