Zaltrap (ziv-aflibercept)
Clinical coverage criteria for medical-benefit use of Zaltrap (ziv-aflibercept) including approved indications, prior authorization criteria, contraindicated combinations, and applicable diagnosis codes. Applies to requests for Zaltrap under the plan's medical benefit and guides approval or denial decisions.
Wording and formatting criteria updates; updated appendiceal cancer to clarify treatment applies to individuals who are not a candidate for surgery for goblet cell appendiceal adenocarcinoma (GCA); removed anal cancer from criteria.
Coverage Summary
Coverage stance: covered_with_criteria. Scope: clinical coverage criteria for medical-benefit use of Zaltrap (ziv‑aflibercept) including approved indication, prior authorization criteria, contraindicated combinations, and applicable diagnosis codes for metastatic/advanced colorectal and select appendiceal adenocarcinomas. Drug and indication: Zaltrap (ziv‑aflibercept) is a recombinant fusion protein approved by the FDA in combination with FOLFIRI (5‑fluorouracil, leucovorin, irinotecan) for treatment of metastatic colorectal cancer that is resistant to or has progressed following an oxaliplatin‑containing regimen.
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