CurrentMass General Brigham Health PlanPolicy N/A

Jevtana (cabazitaxel) — Medical-benefit prior authorization for metastatic castration-resistant prostate cancer

Medical-benefit prior authorization policy for Jevtana (cabazitaxel) in members with metastatic castration-resistant prostate cancer (mCRPC), governing MassHealth members and prescribers (oncologists).

Policy Summary

PayerMass General Brigham Health Plan

PolicyJevtana (cabazitaxel) — prior authorization for mCRPC (medical benefit)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 2024

Next Review DateN/A

Key ActionSubmit prior authorization with documentation showing mCRPC diagnosis, oncologist prescriber, prior docetaxel regimen, dosing with prednisone, and evidence of progression or intolerance.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

prior authprogram type

medical onlybenefit

8 moapproval duration

post-docetaxelline-of-therapy

Coverage Criteria for Jevtana (cabazitaxel)

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Initial Therapy

Authorization may be granted when all the following criteria are met:

Initial coverage criteria for Jevtana: 1. Diagnosis of metastatic castration-resistant prostate cancer (mCRPC); 2. Prescriber is an oncologist; 3. Appropriate dosing; 4. Requested agent will be used in combination with prednisone; 5. Inadequate response (i.e., progression of cancer) or adverse reaction to one docetaxel-containing regimenmust meet all 5 items

Documentation should support each item

Continuation of Therapy

Continuation of therapy (reauthorization)

Continuation criteria: 1. Prescriber resubmits request which will infer a positive response to therapy; 2. Reauthorizations will be granted for up to 8 monthsresubmission infers benefit; approvals up to 8 months

No explicit objective response metrics are required by policy; documentation of ongoing benefit should be available upon request

This policy applies to Jevtana (cabazitaxel) administered under the medical benefit only for eligible MassHealth members. Alternate agents in the same therapeutic class may be available through the pharmacy benefit; providers should consult the MassHealth Drug List for coverage and criteria of pharmacy‑benefit agents.

Use of Jevtana without prior treatment with a docetaxel‑containing regimen or without meeting all of the coverage criteria listed in this policy (including diagnosis of metastatic castration‑resistant prostate cancer, administration by an oncologist, appropriate dosing, and concomitant use with prednisone) is not supported by this policy and may be considered not medically necessary.

Regimen	Indication	Line of therapy	Coverage status
Cabazitaxel (Jevtana) + prednisone	Treatment of metastatic castration-resistant prostate cancer (mCRPC) in patients previously treated with a docetaxel-containing regimen	Second-line (after prior docetaxel)	Covered with criteria

Provider Actions, Documentation, and Prior Authorization

Prior Authorization

Prior Authorization Required

Prior authorization is required for Jevtana (cabazitaxel) under the medical benefit for eligible MassHealth members. Requests for new-to-plan members currently receiving treatment may be reviewed on a case-by-case basis; lack of supporting justification may lead to denial.

Plan: MassHealth (Medical Benefit)
Contact: Medical Benefit phone 833-895-2611; fax 888-656-6671

Step Therapy

No step therapy requirement applies for Jevtana under this policy.

Documentation Required

Required Documentation

Prescriber must document the clinical rationale and supply records demonstrating all required coverage criteria are met. Documentation should include: diagnosis of metastatic castration-resistant prostate cancer (mCRPC); prescriber specialty (oncologist); dosing and schedule consistent with labeled/appropriate dosing; confirmation Jevtana will be administered in combination with prednisone; prior treatment history showing inadequate response or adverse reaction to one docetaxel-containing regimen; and for new-to-plan members, documentation of ongoing treatment if applicable.

Diagnosis: mCRPC
Prescriber specialty: Oncology
Dosing details and schedule
Concurrent use with prednisone confirmed
Prior docetaxel-containing regimen with progression or adverse reaction
For new-to-plan: documentation of current treatment and justification for continuation

Denial Risk

Requests that do not meet the listed criteria (diagnosis, prescriber specialty, appropriate dosing, use with prednisone, or prior docetaxel regimen) or lack required documentation may be denied.

Definitions

mCRPC — definition

DefinitionMetastatic castration-resistant prostate cancer (mCRPC) — prostate cancer that progresses despite castrate levels of testosterone and has metastasized.

Indication contextJevtana (cabazitaxel) is indicated in combination with prednisone for treatment of mCRPC previously treated with a docetaxel-containing regimen.

Clinical implicationmCRPC denotes disease progression despite castration-level testosterone and represents the population eligible for second-line therapy after docetaxel.

Background

Jevtana (cabazitaxel), when used in combination with prednisone, is indicated for treatment of metastatic castration‑resistant prostate cancer (mCRPC) in patients previously treated with a docetaxel‑containing regimen. The policy aligns with the product indication by covering cabazitaxel plus prednisone as a post‑docetaxel (second‑line) option for mCRPC, and requires that requests specify appropriate dosing and that cabazitaxel will be administered with prednisone.