Pharmacy Prior Authorization Criteria

Veppanu (vepdegestrant)

Indications for Prior Authorization

Veppanu (vepdegestrant)

• For diagnosis of Breast Cancer
  Indicated for the treatment of adults with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative, estrogen receptor-1 (ESR1)-mutated advanced or metastatic breast cancer, as detected by an FDA-authorized test, with disease progression following at least one line of endocrine therapy.

Criteria

Veppanu

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)

• Diagnosis of breast cancer
AND
• Disease is one of the following:
• Advanced
• Metastatic
AND
• Disease is human epidermal growth factor receptor 2 (HER2)-negative
AND
• Disease is estrogen receptor (ER)-positive
AND
• Presence of estrogen receptor-1 (ESR1) mutation as detected by a FDA-approved test or a test performed at a facility approved by Clinical Laboratory Improvement Amendments (CLIA)
AND
• Disease has progressed following at least one line of endocrine therapy (e.g., exemestane, tamoxifen, fulvestrant)

Veppanu

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)

• Patient does not show evidence of progressive disease while on therapy

P & T Revisions

2026-07-30

References

1. Prescribing Information Veppanu. Pfizer, New York, May 2026. Accessed July 2026.
2. A Study to Learn About a New Medicine Called Vepdegestrant (ARV-471, PF-07850327) in People Who Have Advanced Metastatic Breast Cancer (VERITAC-2). NCT05654623. Accessed July 2026.
3. NCCN Guidelines version 4.2026, Breast Cancer. Accessed July 2026.

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Revision History

• 2026-07-30: New Program

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