CurrentCignaPolicy N/A

Yonsa (abiraterone acetate) prior authorization for metastatic castration‑resistant prostate cancer

Defines prior authorization requirements and medical necessity criteria for coverage of Yonsa (abiraterone acetate tablets) in the treatment of metastatic castration‑resistant prostate cancer for Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyYonsa (abiraterone acetate) prior authorization for metastatic castration‑resistant prostate cancer

Policy CodePolicy N/A

Change TypeAnnual review — no material changes

Effective Date

Next Review DateApr 17, 2025

Key ActionObtain prior authorization and submit documentation showing FDA‑approved indication plus required concurrent castration and combination steroid to approve for 1 year.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

FDA-approved onlyCoverage stance

1 yearAuth duration

NCCN citedGuideline

Combination requiredSteroid requirement

Coverage Criteria for Yonsa (abiraterone acetate)

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inv-01: FDA‑Approved Indication — Covered when ALL of the following are met

Covered when ALL of the following are met

FDA‑Approved Indication criteria set: 1) Indication: metastatic castration‑resistant prostate cancer; AND 2) The medication is used in combination with methylprednisolone or dexamethasone; AND 3) Patient meets ONE of the following: (i) the medication is concurrently used with a gonadotropin‑releasing hormone (GnRH) analog (examples provided) OR (ii) patient has had a bilateral orchiectomy.

Approve for 1 year when all conditions met

Yonsa (abiraterone acetate tablets) is considered not medically necessary for any use(s) other than those specified in this policy. Coverage will be limited to the indications and clinical conditions described in the policy and will be updated if new published data warrant a change.

Any request for Yonsa for indications is considered not medically necessary and may be denied per the terms of the applicable benefit plan.

Regimens and Combination Therapy

Regimen	Indication / Notes	Coverage status
Yonsa (abiraterone acetate) + methylprednisolone	Indicated for metastatic castration‑resistant prostate cancer (CRPC); recommended in NCCN guidelines as a category 2A option for metastatic CRPC and in multiple NCCN contexts when used with ADT or other agents; approve for 1 year when criteria met	Covered
Yonsa (abiraterone acetate) + dexamethasone	Alternative corticosteroid option noted for use in metastatic CRPC and in settings of prior therapy or progression on prior abiraterone formulations per NCCN guidance	Covered

Provider Actions and Authorization Requirements

Prior Authorization

Prior Authorization Recommended

Prior Authorization is recommended for prescription benefit coverage of Yonsa. Approvals are provided for the duration noted in the policy (e.g., approve for 1 year when criteria are met). Providers should submit requests to the plan's prior authorization process with clinical documentation supporting the indication and regimen.

Yonsa (abiraterone acetate tablets - Sun Pharmaceutical) requires prior authorization for coverage.
Typical approval duration: 1 year when FDA‑approved metastatic castration‑resistant prostate cancer criteria are met.

Documentation Required

Supporting Documentation Required

Documentation must demonstrate the clinical rationale for Yonsa, including diagnosis, prior treatments, concurrent medications (especially corticosteroid and androgen‑suppression therapy), and relevant operative history (e.g., bilateral orchiectomy if applicable). Coverage determinations will follow the member's benefit plan terms.

Provide evidence of metastatic castration‑resistant prostate cancer diagnosis.
Document concurrent use of methylprednisolone or dexamethasone.
If applicable, document bilateral orchiectomy or use of a GnRH analog/antagonist.

Step Therapy

Step Therapy / History Note

There are no step‑therapy requirements specified in this policy. The policy history indicates wording changes (e.g., 'agonist' changed to 'analog') and examples updated, but no step therapy or required prior trials of alternative agents are required prior to approval.

Policy history: 07/12/2023, 08/07/2024, 04/17/2025, 07/30/2025 — no step therapy added.

Denial Risk

Non‑covered Uses / Denial Risk

Requests for Yonsa for indications or uses other than the specified FDA‑approved indication (metastatic castration‑resistant prostate cancer) are considered not medically necessary and will be denied unless new published evidence or benefit plan language supports coverage.

Yonsa is not covered for ANY other use(s) outside the policy criteria.
Coverage criteria will be updated as new published data become available.

Line of Therapy

inv-11: first-line — 1 top-level node describing line-of-therapy position

NCCN contexts noted: NCCN lists Yonsa plus a corticosteroid across multiple contexts including regional node disease with EBRT+ADT (category 2B option), castration‑naïve M1 disease (category 2B with ADT), and metastatic castration‑resistant prostate cancer as a category 2A option in specified settings.

Policy enforces FDA‑approved CRPC indication; NCCN referenced for context

Definitions and Concurrent Castration

Concurrent castration — definition and examples

DefinitionConcurrent castration: use of a gonadotropin-releasing hormone (GnRH) analog or prior bilateral orchiectomy.

Examples of GnRH analogs (listed in policy)Leuprolide acetate (Lupron Depot), Trelstar (triptorelin pamoate), Zoladex (goserelin acetate implant), Vantas (histrelin acetate implant).

Additional agents citedFirmagon (degarelix subcutaneous injection), Orgovyx (relugolix tablets).

Usage contextRequired as part of combination therapy for metastatic castration‑resistant prostate cancer when approving Yonsa.

Approval duration when criteria metApprove for 1 year if concurrent castration and steroid combination criteria are satisfied.