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New Aetna Policy for PSMA Screening for PLUVICTO Radioligand Therapy

Reno, Nevada (UroToday.com) -- Aetna has updated and published its coverage policy for prostate-specific membrane antigen (PSMA) imaging for PluvictoTM (lutetium Lu 177 vipivotide tetraxetan) (formerly referred to as 177Lu-PSMA-617) therapy eligibility. Aetna now covers hormone and chemo refractory metastatic castration-resistant prostate cancer (mCRPC) patients with PSMA avid disease imaged with any of the approved PSMA agents including PYLARIFY® (piflufolastat F 18) injection (also known as 18F-DCFPyL or PyL). Importantly the policy does not specify imaging with 68Ga-PSMA-611. The highlights of the policy are:

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
  • The member has been treated with androgen receptor (AR) pathway inhibition (e.g., abiraterone) and taxane-based chemotherapy (e.g., docetaxel); and
  • The disease is prostate-specific membrane antigen (PSMA)-positive.
Aetna considers lutetium Lu 177 vipivotide tetraxetan (Pluvicto) experimental and investigational for all other indications. 

The full policy determination is available to view at: http://www.aetna.com/cpb/medical/data/900_999/0929.html

References: 
Lutetium Lu 177 Dotatate (Lutathera) and Lutetium Lu 177 Vipivotide Tetraxetan (Pluvicto) - Medical Clinical Policy Bulletins | Aetna. (2022). Retrieved 27 June 2022, from http://www.aetna.com/cpb/medical/data/900_999/0929.html

Source: Digital Science Press© 2022