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.
Ziv-aflibercept (Ziltrap) may be considered medically necessary for the treatment of ANY of the following conditions:
Food and Drug Administration (FDA) Indication
- Treatment for metastatic colorectal cancer (mCRC) that is resistant to or has progressed following an oxaliplatin-containing regimen, in combinations with FOLFIRI (5-fluorouracil, leucovorin, and irinotecan); or
National Comprehensive Cancer Network (NCCN) Recommendations
Colon or Rectal Cancer - Adenocarcinoma
- Primary treatment for individuals with unresectable metachronous metastases and previous adjuvant FOLFOX (fluorouracil, leucovorin, and oxaliplatin) or CapeOX (capecitabine and oxaliplatin) within the past 12 months in combination with:
- Irinotecan; or
- FOLFIRI regimen; or
- Adjuvant treatment in combination with FOLFIRI or irinotecan for unresectable metachronous metastases that converted to resectable disease after primary treatment; or
- Subsequent therapy for progression of advanced or metastatic disease in combination with irinotecan or FOLFIRI regimen not previously treated with irinotecan-based regimens.
Ziv-aflibercept (Ziltrap) is considered experimental/investigational for all other indications and therefore non-covered. Scientific evidence does not support its use for any other indications.