CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A
enzalutamide (Xtandi) for prostate cancer
Defines covered indications, exclusions, authorization durations, and continuation criteria for enzalutamide (Xtandi) including FDA-approved and compendial uses for prostate cancer. Applies when approval criteria are met and member has no exclusions to the prescribed therapy.
Policy Summary
PayerNeighborhood Health Plan of Rhode Island
Policyenzalutamide (Xtandi) for prostate cancer
Policy CodePolicy N/A
Change TypeNo material change
Effective Date
Next Review Date
Key ActionAuthorization may be granted for 12 months per indicated diagnosis and requires meeting indication-specific requirements (e.g., bilateral orchiectomy or concurrent LHRH agonist/antagonist for CRPC and mCSPC).
POLICY UPDATE CHANGES
No material clinical/coverage changes
3FDA-Approved Indications Listed
1Compendial Indication Category
12Standard Authorization Duration (months)
Coverage Summary
Defines coverage for FDA-approved and compendial prostate cancer indications for enzalutamide (Xtandi) — specifically CRPC, mCSPC, and nmCSPC with high-risk BCR — and states that these uses are covered only when all approval criteria are met and the member has no exclusions to the prescribed therapy.