CurrentCignaPolicy N/A

Cometriq Prior Authorization Policy

This policy establishes prior authorization requirements and coverage criteria for Cometriq (cabozantinib capsules) under Cigna-administered health benefit plans, including FDA-approved indication and select evidence-supported uses, approval durations, and not medically necessary uses.

Policy Summary

PayerCigna

PolicyCometriq Prior Authorization Policy

Policy CodePolicy N/A

Change TypeClarified and Revised

Effective Date

Next Review Date

Key ActionPrior authorization is recommended/required for Cometriq; submit documentation supporting age, diagnosis (including RET rearrangement for NSCLC), prior therapies, and radioactive iodine refractory status as applicable.

SourceLink

POLICY UPDATE CHANGES

Thyroid Carcinoma, Differentiated: changed Hürthle cell carcinoma name to 'oncocytic carcinoma (formerly Hürthle cell carcinoma)' based on guideline changes.

Non-Small Cell Lung Cancer: added requirement that patient has recurrent, advanced, or metastatic disease and has progressed on Gavreto or Retevmo (first-line therapies).

Annual revisions recorded with review dates 06/07/2023 and 06/12/2024 noting no criteria changes for those reviews.

1FDA-Approved Indications Covered

2Other Evidence-Supported Uses Covered Conditionally

1Explicitly Not Covered Indications

Coverage Summary & Criteria

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This policy establishes prior authorization requirements and coverage criteria for Cometriq (cabozantinib capsules) under Cigna-administered health benefit plans. Coverage stance: covered_with_criteria. Approvals are provided for specified durations, typically 1 year, when the applicable clinical criteria are met.

FDA-Approved Indication

Covered when ALL of the following are met:

ALL of the following

Indication: Thyroid Carcinoma, Medullary
Patient is ≥ 18 years of age
Approval duration: 1 year

Other Uses with Supportive Evidence - Non-Small Cell Lung Cancer

Approve for 1 year if the patient meets ALL of the following (A, B, C, and D):

ALL of the following

A: Patient is ≥ 18 years of age
B: Patient has recurrent, advanced, or metastatic disease
C: Patient has RET gene rearrangement-positive tumor
D: Patient has progressed on one of the first-line therapies, Gavreto (pralsetinib) or Retevmo (selpercatinib)
Approval duration: 1 year

Other Uses with Supportive Evidence - Thyroid Carcinoma, Differentiated

Approve for 1 year if the patient meets ALL of the following (A, B, C and D):

ALL of the following

A: Patient is ≥ 12 years of age
B: Patient has differentiated thyroid carcinoma (examples include papillary, follicular, and oncocytic carcinoma)
C: Disease is refractory to radioactive iodine therapy
D: Patient has tried Lenvima (lenvatinib) or sorafenib

Not Medically Necessary

Cometriq is considered not medically necessary for ANY other use(s) including:

ANY of the following

Metastatic Castration-Resistant Prostate Cancer (mCRPC) based on COMET-1 study failing to meet primary OS endpoint

Prior Authorization & Documentation Requirements

Prior Authorization

Prior authorization required

Prior authorization is recommended/required for prescription benefit coverage of Cometriq. Approvals are provided for the durations specified by the policy, typically for 1 year.

Documentation Required

Clinical documentation required to support indication

Documentation should support the patient’s age and diagnosis, including RET gene rearrangement status for NSCLC, prior therapies (for NSCLC: progression on Gavreto or Retevmo; for differentiated thyroid carcinoma: prior lenvatinib or sorafenib), and radioactive iodine refractory status where applicable.

Patient age
Diagnosis and RET rearrangement status for NSCLC
Prior therapies (e.g., progression on Gavreto or Retevmo for NSCLC; prior lenvatinib or sorafenib for differentiated thyroid carcinoma)
Radioactive iodine refractory status (for differentiated thyroid carcinoma)

Denial Risk

Denial for non-covered indications

Claims for uses that do not meet the policy criteria may be denied as not medically necessary. The policy explicitly lists metastatic castration‑resistant prostate cancer (mCRPC) as not medically necessary based on the COMET‑1 trial.

mCRPC — COMET‑1 trial failed to meet primary OS endpoint

Evidence & Trial Results

Cabozantinib 11.0 mo vs 9.8 moCOMET-1 (mCRPC) median OS — not statistically significant

Other evidence-supported uses: 2NSCLC (RET-rearranged after Retevmo/Gavreto) and Differentiated Thyroid Carcinoma

Evidence from the COMET-1 Phase III trial in metastatic castration-resistant prostate cancer (mCRPC) showed a median overall survival of 11.0 months (cabozantinib) vs 9.8 months (prednisone), which was not statistically significant; based on these results, cabozantinib for mCRPC is determined to be not medically necessary under this policy. Contextual note: the guideline-based renaming of Hürthle cell carcinoma to oncocytic carcinoma (formerly Hürthle cell carcinoma) is recorded for clarity.

Background & Definitions

Cometriq (cabozantinib) is a kinase inhibitor indicated for the treatment of patients with progressive, metastatic medullary thyroid cancer. NCCN guidelines reference cabozantinib as a preferred agent (category 1) for recurrent or persistent medullary thyroid cancer that is locoregional or metastatic, and list cabozantinib as an option for differentiated thyroid carcinoma subtypes (papillary, follicular, oncocytic) when disease is refractory to radioactive iodine and after prior therapy with lenvatinib or sorafenib.

NCCN guidance for Non-Small Cell Lung Cancer (version 3.2025) supports use of cabozantinib as subsequent therapy for RET gene rearrangement-positive tumors after progression on first-line Retevmo (selpercatinib) or Gavreto (pralsetinib). The policy reflects these guideline positions and places cabozantinib within the context of subsequent therapy where applicable.

Oncocytic carcinoma: Formerly Hürthle cell carcinoma, renamed per guideline changes.

Policy Revision History

06/07/2023annual_review

Annual revision recorded; changed naming of Hürthle cell carcinoma to 'oncocytic carcinoma (formerly Hürthle cell carcinoma)' for differentiated thyroid carcinoma per guideline updates.

06/12/2024annual_review

Annual revision recorded; no criteria changes noted for this review.

05/07/2025material_revisionLatest

Non-Small Cell Lung Cancer criteria revised to add requirement that patient has recurrent, advanced, or metastatic disease and has progressed on first-line RET agents Gavreto (pralsetinib) or Retevmo (selpercatinib).

Policy Summary

PayerCigna

PolicyCometriq Prior Authorization Policy

Policy CodePolicy N/A

Change TypeClarified and Revised

Effective Date

Next Review Date

SourceLink

On This Page

OpenPayer

Cometriq Prior Authorization Policy

Coverage Summary & Criteria

Applicable Codes

Prior Authorization & Documentation Requirements

Evidence & Trial Results

Background & Definitions

Policy Revision History