CurrentCignaPolicy N/A

Oncology - Sunitinib Prior Authorization Policy

Defines Cigna's prior authorization requirements and coverage criteria for sunitinib (Sutent®) under applicable health benefit plans, including FDA‑approved indications and other supported oncology uses for adults.

Policy Summary

PayerCigna

PolicyOncology - Sunitinib Prior Authorization Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateJul 23, 2025

Key ActionObtain prior authorization and submit supporting clinical documentation consistent with the applicable benefit plan for sunitinib requests.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

FDA & evidence-basedindications covered

1 yearapproval duration

≥18 yrsage requirement

NCCNcompendia

Coverage Criteria for Sunitinib (Sutent)

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Indication‑specific coverage criteria

Covered when the following indication‑specific criteria are met (approvals generally for 1 year):

Gastrointestinal Stromal Tumor (GIST): Approve for 1 year if A) patient is >= 18 years of age AND B) patient meets ONE of the following: i) patient has tried imatinib; OR ii) patient has succinate dehydrogenase (SDH)-deficient gastrointestinal stromal tumor.

FDA‑approved indication

Pancreatic Neuroendocrine Tumors: Approve for 1 year if A) patient is >= 18 years of age AND B) patient has advanced or metastatic disease.

FDA‑approved indication

Renal Cell Cancer: Approve for 1 year if A) patient is >= 18 years of age AND B) patient has relapsed or advanced disease.

FDA‑approved indication

Bone Cancer (Recurrent Chordoma): Approve for 1 year if A) patient is >= 18 years of age AND B) patient has recurrent chordoma.

Other use with supportive evidence (NCCN)

Meningioma: Approve for 1 year if A) patient is >= 18 years of age AND B) patient has recurrent or progressive disease.