Zachary Contreras, Pharm.D.

An expert discusses how health plans must defend all formulary decisions with clinical evidence and use NCCN/AUA guidelines to create treatment pathways rather than traditional tier placements, with BCG-unresponsive cases following a step-therapy approach from gemcitabine/docetaxel to nadofaragene based on cost and toxicity profiles.

An expert discusses how health plans establish coverage policies by referring to clinical trials, NCCN guidelines and disease association recommendations, using trial qualifying criteria to draft prior authorization requirements that are then reviewed by specialists before committee presentation.