Oncology – Erleada Prior Authorization Policy - (CNF509)
Defines prior authorization requirements and medical necessity criteria for coverage of Erleada (apalutamide tablets) for FDA‑approved indications (non‑metastatic castration‑resistant prostate cancer and castration‑sensitive prostate cancer) when used with androgen deprivation therapy or after bilateral orchiectomy. Also states non‑coverage for other uses.
Changed wording from 'GnRH agonist' to 'GnRH analog' allowing both agonists and antagonists and added Firmagon and Orgovyx as examples.
Added approval option for patients with high‑risk second biochemical recurrence in castration‑sensitive prostate cancer with definition of high‑risk attributes.
Policy name updated to 'Oncology (Oral - Androgen Receptor Inhibitor) - Erleada PA Policy'.
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.