Pluvicto prior authorization criteria

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August undefined, 2024

WebMar 23, 2024 · On March 23, 2024, the Food and Drug Administration approved Pluvicto (lutetium Lu 177 vipivotide tetraxetan, Advanced Accelerator Applications USA, Inc., a … Web{"requestHeader":{"consumer":{"name":"PORTAL","id":"UnKnown","businessUnit":null,"type":"UnKnown","clientVersion":null,"requestDateTime":null,"hostName":"UnKnown ...

Pluvicto™ Added To Preauthorization List August 1, 2024

WebCriteria for Approval Authorization of a single treatment given every six weeks for up to six doses may be granted to patients 18 years of age or older for treatment of prostate … WebFeb 14, 2024 · The recommended PLUVICTO dosage is 7.4 GBq (200 mCi) intravenously every 6 weeks for up to 6 doses, or until disease progression, or unacceptable toxicity. 2.4 Dosage Modifications for Adverse Reactions Recommended dosage modifications of PLUVICTO for adverse reactions are provided in Table 1. aqualine bundaberg

PET Scan: Prostate Cancer

WebMay 1, 2024 · As an indication of how quickly the field of nuclear medicine is advancing, the Appropriate Use Criteria (AUC) for Prostate-Specific Membrane Antigen (PSMA) PET document has been updated ( 1 ). This is due to the recent U.S. Food and Drug Administration (FDA) approval of 177 Lu-PSMA-617 (Pluvicto, 177 Lu-vipivotide … WebCriteria for Initial Approval Prostate Cancer Aetna considers lutetium Lu 177 vipivotide tetraxetan (Pluvicto) medically necessary for treatment (up to 6 total doses) of prostate cancer when all of the following criteria are met: The member has metastatic castration-resistant prostate cancer; and WebNo Prior Authorization Not covered X Pluvicto (lutetium Lu 177 vipivotide tetraxetan) is a radioligand therapeutic agent indicated for the treatment of ... 1. Criteria for Approval Authorization of a single treatment given every six weeks for up to six doses may be granted to patients 18 ... treatment with Pluvicto must be discontinued. Codes baiburin

***Coverage of gene therapies is not addressed in this …

Drug and Biologic Medical Necessity (Injectables) - Cigna

WebPLUVICTO is indicated for the treatment of adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) who … http://resources.allwayshealthpartners.org/medicalpolicy/Pluvicto.pdf baibu seat padsWeb• Pluvicto meets a need in the third-line setting for mCRPC, providing a new mechanism of action that can be used in patients with prostate-specific membrane antigen (PSMA) + metastatic CRPC. Considering that PSMA is expressed in > 80% of men with prostate cancer, Pluvicto is likely to be highly utilized in this late-stage prostate cancer baiburguer brasilia

"WebFeb 2, 2024 · Authorised This medicine is authorised for use in the European Union. Overview Pluvicto is a medicine used to treat cancer of the prostate (a gland of the male … " - Pluvicto prior authorization criteria

Pluvicto prior authorization criteria

Updates to Appropriate Use Criteria for PSMA PET

WebCoverage of Pluvicto is recommended in those who meet the following criteria: FDA-Approved Indication 1. Prostate Cancer - Metastatic Castration Resistant (mCRPC). … WebPrior Authorization is recommended for medical benefit coverage of Pluvicto. Approval is recommended for those who meet the Criteria and Dosing for the listed indication. …

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WebJul 5, 2024 · IV. Renewal Criteria 1 Coverage can be renewed based upon the following criteria: • Patient continues to meet universal and other indication-specific relevant … WebPluvicto is indicated for the treatment of adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) who …

WebAdditional selection criteria were used in the VISION study [see Clinical Studies (14)]. Refer to the prescribing information for the PSMA imaging agent. ... •Confirm the amount of radioactivity delivered to the patient with an appropriately calibrated dose calibrator prior to and after PLUVICTO administration. WebJul 5, 2024 · III. Initial Approval Criteria 1 Coverage is provided in the following conditions: Patient is at least 18 years of age; AND Universal Criteria 1,2 Patient will receive concurrent treatment with a GnRH-analog or has had a bilateral orchiectomy; AND …

WebReceptor Targeted Radiotherapy (Azedra, Lutathera, Pluvicto, Zevalin) Document #: ING-CC-0118 . Publish Date: 06/20/2024 : Status: Revised : ... A scale and criteria used by doctors and researchers to assess ... (including prior authorization), the following criteria will be used to determine whether the drug meets any applicable medical necessity WebDec 20, 2024 · C. Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) pretreatment evaluation *NOTE: Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) may require a separate authoriza-tion by payor. Authorization should be completed prior to request for pretreatment PMSA PET. [1] D. Risk factors of ALL of the following: 1. Classification of cT2b, cT2c, cT3a, cT3b ...

WebPRIOR AUTHORIZATION LIST . ... *Site of Care Criteria Applies (PC/S009) A list of drugs subject to Site of Care can be found here . ... •Pluvicto (LU 177 Vipivotide tetraxetan) A9607 •Polivy (polatuzumab vedotin-piiq) J9309 •Poteligeo (mogamulizumab-kpkc) J9204

WebLutetium Lu 177 vipivotide tetraxetan 1000MBq/mL (27mCi/mL); soln for IV inj or infusion; preservative-free. baibusumadaraWebAnemia, thrombocytopenia, leukopenia, or neutropenia. Grade 2: Withhold until improvement to Grade 1 or baseline. Grade ≥3: Withhold until improvement to Grade 1 or … aqualina inn montauk nyWeb• PMA of Less than 30 Weeks: 20 mg/kg every 12 hours for 21 days. Varicella Zoster Infections: Zoster in Immunocompromised Patients: • ≥ 12 years of age: 10 mg/kg every 8 hours for 7 days to 10 days. • < 12 years: 10 mg/kg every 8 hours for 7 days to 10 days. aqualine tukwilaWebJan 16, 2024 · One mL of solution contains 1,000 MBq of lutetium (177 Lu) vipivotide tetraxetan at the date and time of calibration.Physical characteristics. Lutetium-177 has a half-life of 6.647 days. Lutetium-177 decays by β-emission to stable hafnium-177 with the most abundant β-(79.3%) having a maximum energy of 0.497 MeV. The average beta … aqualina montaukWebBefore administration of PLUVICTO, you should drink plenty of water in order to urinate as often as possible during the first hours after administration. The most common side … aqualing hunyadiWebGrade 2: Withhold until improvement to Grade 1 or baseline Grade ≥3: Withhold until improvement to Grade 1 or baseline, reduce dose by 20% to 5.9 GBq (160 mCi) Recurrent Grade >3 myelosuppression... aqua liners kenyaWebPluvicto Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered. To make an appropriate determination, providing the most accurate diagnosis for the use of the baibuyi