Pharmacy Prior Authorization Criteria

Truqap (capivasertib)

Indications for Prior Authorization

Truqap (capivasertib)

• For diagnosis of Breast Cancer
  Indicated, in combination with fulvestrant for the treatment of adult patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer with one or more PIK3CA/AKT1/PTEN-alterations as detected by an FDA-approved test following progression on at least one endocrine-based regimen in the metastatic setting or recurrence on or within 12 months of completing adjuvant therapy.

• For diagnosis of Prostate Cancer
  Indicated, in combination with abiraterone and prednisone, for the treatment of adult patients with metastatic androgen pathway modulation-naïve or -sensitive (mAPMN/S) prostate cancer that is PTEN-deficient as detected by an FDA-authorized test.

Criteria

Truqap

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)
For diagnosis of Breast Cancer

• Diagnosis of breast cancer
AND
• Disease is one of the following:
• Locally advanced
• Metastatic
AND
• Will be taken in combination with fulvestrant
AND
• Disease is hormone receptor (HR)-positive
AND
• Disease is human epidermal growth factor receptor 2 (HER2)-negative
AND
• Presence of one or more PIK3CA/AKT1/PTEN-alterations as detected by a FDA-approved test or a test performed at a facility approved by Clinical Laboratory Improvement Amendments (CLIA)
AND
• One of the following:
• Disease has progressed following at least one endocrine-based regimen in the metastatic setting (e.g., anastrozole, letrozole, exemestane, tamoxifen, etc).
OR
• Recurrence of disease on or within 12 months of completing adjuvant therapy (e.g., chemotherapy)

Truqap

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of Breast Cancer

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

Truqap

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)
For diagnosis of Prostate Cancer

• Diagnosis of prostate cancer
AND
• Disease is metastatic
AND
• Used in combination with abiraterone and prednisone
AND
• Disease is androgen pathway modulation-naïve or -sensitive (mAPMN/S)
AND
• Tumor is PTEN deficient as detected by a FDA approved test or a test performed at a facility approved by Clinical Laboratory Improvement Amendments (CLIA)

Truqap

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of Prostate Cancer

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

P & T Revisions

2026-07-29, 2026-01-20, 2025-02-04, 2024-11-26, 2024-01-18, 2024-01-03

References

1. Truqap Prescribing Information. AstraZeneca Pharmaceuticals LP. Wilmington, DE. Accessed July 2026.

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Revision History

• 2026-07-29: New criteria for new indication of prostate cancer
• 2026-01-20: 2026 annual review; minor verbiage updates.
• 2025-02-04: Annual review: No criteria changes.
• 2024-11-26: Added new 160mg and 200mg therapy packs to guideline
• 2024-01-18: Removed OptumRx SP formulary and added OptumRx formulary instead
• 2024-01-03: New Program for Truqap

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