Fulvestrant: Faslodex®; Fulvestrant (Intramuscular)
Outlines medical necessity, dosing, indications, authorization length, renewal criteria, billing codes (HCPCS/NDC), and covered ICD-10 diagnoses for fulvestrant for commercial (non-Medicare) members of Viva Health. Includes specific coverage criteria for breast, ovarian, endometrial cancers and uterine sarcoma.
No material changes
Coverage Summary
Outlines medical necessity, dosing, covered ICD-10 diagnoses, and authorization length for fulvestrant in commercial (non‑Medicare) members. Indications covered include HR‑positive advanced or metastatic breast cancer (with multiple specified first‑line, subsequent, and post‑CDK4/6 scenarios), recurrent low‑grade serous ovarian cancer (epithelial/fallopian tube/primary peritoneal), grade 1–2 endometrioid endometrial carcinoma, and selected uterine sarcomas. Initial authorization is provided for 6 months with renewal allowed when criteria are met. Overall coverage stance: covered_with_criteria.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.