UTILIZATION MANAGEMENT MEDICAL POLICY
Defines prior authorization recommendations, coverage criteria, dosing limits, and exclusions for medical-benefit valrubicin (Valstare) for intravesical treatment of BCG-refractory carcinoma in situ of the urinary bladder.
Annual Revision, Summary of Changes = No criteria changes.
Coverage Summary
Covered with criteria: intravesical valrubicin (Valstare) for BCG‑refractory carcinoma in situ (CIS) of the urinary bladder when immediate cystectomy would have unacceptable morbidity or mortality, per the FDA‑approved indication. NCCN (Bladder Cancer Clinical Practice Guidelines, version 5.2024, Oct 28, 2024) recommends intravesical valrubicin for BCG‑refractory CIS and as an option during BCG shortages. Authorization follows the policy criteria and dosing limits.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.