Firmagon (degarelix) (Subcutaneous) — Prior Authorization Criteria
Prior authorization policy for degarelix (Firmagon) subcutaneous injection for treatment of prostate cancer in adult members; defines dosing, authorization length, renewal, and covered ICD-10 diagnoses.
No material clinical or coverage changes in this revision.
Coverage Criteria for Degarelix (Firmagon)
Initial Therapy
Covered when ALL of the following are met:
Initial Approval
- Age: Patient is >= 18 years
- Indication: Diagnosis of prostate cancer (see covered ICD-10 codes)
Includes FDA approved and compendia-recommended indications
Renewal Therapy
Renewal provided when ALL of the following are met:
Renewal
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