CurrentNeighborhood Health Plan of Rhode IslandPolicy 2498-A

Erleada (apalutamide) coverage for prostate cancer

Policy governs coverage and authorization criteria for Erleada (apalutamide) for FDA-approved indications and compendial uses in prostate cancer, including non-metastatic castration-resistant and metastatic castration-sensitive disease, and continuation/reauthorization rules. Exclusions and combination-therapy restrictions are specified.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyErleada (apalutamide) coverage for prostate cancer

Policy CodePolicy 2498-A

Change Typeclarified

Effective Date

Next Review Date

Key ActionAuthorization may be granted for 12 months for initial and continuation therapy when criteria are met; document bilateral orchiectomy or planned/ongoing use of a GnRH agonist or degarelix for eligibility.

SourceLink

POLICY UPDATE CHANGES

Policy includes FDA-approved indications for non‑metastatic castration‑resistant prostate cancer (nmCRPC) and metastatic castration‑sensitive prostate cancer (mCSPC), compendial prostate cancer uses, and 12‑month authorization language.

2FDA‑approved indications listed

1Compendial use category (prostate cancer)

Coverage Summary

Policy governs coverage and authorization criteria for Erleada (apalutamide) for FDA-approved indications and compendial uses in prostate cancer. It covers the FDA-approved indications non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-sensitive prostate cancer (mCSPC), and also permits compendial use for prostate cancer per the NCCN Drugs & Biologics Compendium, provided all approval criteria are met and the member has no exclusions to the prescribed therapy. Special requirements and authorization conditions (including orchiectomy or concurrent GnRH agonist/degarelix for certain indications) are specified in the policy.

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