CurrentCignaPolicy N/A

Oncology (Oral -Androgen Biosynthesis Inhibitor) -Authorization Policy Yonsa Prior

This Cigna coverage policy defines prior-authorization requirements and medical necessity criteria for Yonsa (abiraterone acetate tablets) used for metastatic castration-resistant prostate cancer (mCRPC), including required concomitant corticosteroid and androgen-deprivation status. It states that Yonsa is not medically necessary for other uses.

Policy Summary

PayerCigna

PolicyOncology (Oral -Androgen Biosynthesis Inhibitor) -Authorization Policy Yonsa Prior

Policy CodePolicy N/A

Change TypeClarified / Administrative

Effective Date

Next Review DateApr 17, 2025

Key ActionObtain prior authorization and document concomitant methylprednisolone or dexamethasone plus either concurrent GnRH analog use (or specify which) or prior bilateral orchiectomy; approvals are provided for 1 year when criteria are met.

SourceLink

POLICY UPDATE CHANGES

Criterion language changed from requiring a GnRH 'agonist' to 'analog' to allow both agonists and antagonists; Firmagon and Orgovyx were added as examples.

A separate criterion previously asking for concurrent use with Firmagon was deleted.

Policy name changed to 'Oncology (Oral - Androgen Biosynthesis Inhibitor) - Yonsa PA Policy'.

Annual revision noted with no criteria changes (07/12/2023 and 07/30/2025).

1Covered Indication (mCRPC)

1 yrTypical approval duration

Coverage Summary

This Cigna coverage policy defines prior-authorization requirements and medical necessity criteria for Yonsa (abiraterone acetate tablets) used for metastatic castration-resistant prostate cancer (mCRPC), including the requirement for concomitant corticosteroid and documentation of androgen-deprivation status.

Yonsa is an androgen biosynthesis inhibitor indicated in combination with a corticosteroid for treatment of metastatic castration-resistant prostate cancer and is included as an option in the NCCN Prostate Cancer guidelines; typical approvals are for 1 year and there is 1 covered indication (mCRPC).

Covered Indicationmetastatic castration-resistant prostate cancer (mCRPC)

Approval duration1 year

Medical Necessity Criteria

FDA-Approved Indication: Prostate Cancer - Metastatic, Castration-Resistant

Approve for 1 year if the patient meets BOTH of the following (A and B):

ALL of the following

The medication is used in combination with methylprednisolone or dexamethasone.
Must be concomitant corticosteroid: methylprednisolone or dexamethasone
Patient androgen-deprivation status (ONE of):
- The medication is concurrently used with a gonadotropin-releasing hormone (GnRH) analog.
- Patient has had a bilateral orchiectomy.

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Conditions Not Covered

Yonsa is considered not medically necessary for any other use(s).

Use of Yonsa for indications other than metastatic castration-resistant prostate cancer as specified in the FDA-approved indication and above criteria.

Provider Actions & Prior Authorization

Prior Authorization

Prior authorization required

Prior authorization is required for prescription benefit coverage of Yonsa. When the medical necessity criteria are met for the FDA‑approved indication (metastatic castration‑resistant prostate cancer), approvals are provided for a duration of 1 year.

Typical approval duration: 1 year when criteria are met

Documentation Required

Documentation of concomitant therapies

Providers must document that Yonsa is being used in combination with methylprednisolone or dexamethasone and must document the patient’s androgen‑deprivation status by either noting concurrent use of a GnRH analog (examples include leuprolide acetate [Lupron Depot], triptorelin pamoate [Trelstar], goserelin acetate [Zoladex], histrelin acetate [Vantas], degarelix [Firmagon], relugolix [Orgovyx]) or evidence of a prior bilateral orchiectomy.

Coding

DrugNDCCovered

No codes listed

Background, Evidence & Definitions

Yonsa (abiraterone acetate) is an androgen biosynthesis inhibitor indicated in combination with methylprednisolone (or dexamethasone per policy criteria) for the treatment of patients with metastatic castration-resistant prostate cancer.

The National Comprehensive Cancer Network (NCCN) Prostate Cancer Clinical Practice Guidelines (version 2.2025) list Yonsa with methylprednisolone as a recommended option across several prostate cancer scenarios, including metastatic castration-resistant disease (category recommendations vary by setting).

Source	Reference
Prescribing information	Yonsa tablets prescribing information, Sun Pharmaceutical; March 2022
Guideline	NCCN Prostate Cancer Clinical Practice Guidelines in Oncology (version 2.2025 - April 16, 2025)

GnRH analog: Gonadotropin-releasing hormone (GnRH) analogs include both agonists and antagonists used for androgen deprivation; examples listed in the policy include leuprolide acetate (Lupron Depot), triptorelin pamoate (Trelstar), goserelin acetate (Zoladex), histrelin acetate (Vantas), degarelix (Firmagon), and relugolix (Orgovyx).

Revision History

07/12/2023annual_revision

Annual revision — No criteria changes; criterion language changed from requiring a GnRH 'agonist' to 'analog' to allow both agonists and antagonists; Firmagon and Orgovyx were added as examples; the separate criterion previously asking for concurrent use with Firmagon was deleted.

08/07/2024annual_revision

Annual revision (recorded; summary not detailed in brief).

04/17/2025administrative_change

Administrative/name change: Policy name changed to 'Oncology (Oral - Androgen Biosynthesis Inhibitor) - Yonsa PA Policy'.