Coverage is subject to the specific terms of the member’s benefit plan.
Federal Employee Program members (FEP) should check with their Retail Pharmacy Program to determine if prior approval is required by calling the Retail Pharmacy Program at 1-800-624-5060 (TTY: 1-800-624-5077). FEP members can also obtain the list through the www.fepblue.org website.
Sacituzumab govitecan (Trodelvy) may be considered medically necessary in individuals 18 years of age and older for the following conditions:
Food and Drug Administration (FDA) Indications
Metastatic Triple-Negative Breast Cancer (mTNBC)
- As treatment for mTNBC in individuals who have received at least two prior therapies for metastatic disease; or
National Comprehensive Cancer Network (NCCN) Recommendations
- As treatment of recurrent or stage IV (M1) triple-negative disease in individuals who have received at least 2 prior therapies for metastatic disease.
Sacituzumab govitecan (Trodelvy) is considered experimental/investigational for all other indications. Scientific evidence does not support its use for any other indications not listed above.