fezolinetant — Blue Cross Blue Shield of Alabama

moderate to severe vasomotor symptoms due to menopause

Initial criteria

Patient has a diagnosis of vasomotor symptoms
Patient is menopausal
Patient’s symptoms are moderate to severe (≥7 episodes per day or ≥50 episodes per week)
Baseline hepatic function (ALT, AST, total and direct bilirubin) has been evaluated prior to starting therapy
Hepatic transaminases are <2× upper limit of normal and total bilirubin is normal
ONE of the following: - Patient has tried and had an inadequate response to at least ONE menopausal hormone therapy (estrogen therapy or estrogen plus progesterone therapy, including oral, transdermal, sprays, gels, and vaginal ring) - OR patient has an intolerance or hypersensitivity to at least ONE menopausal hormone therapy - OR patient has an FDA labeled contraindication to ALL menopausal hormone therapies - OR patient is age ≥60 years or onset of menopause was ≥10 years prior

Patient has been treated with the requested agent within the past 90 days (continuation of therapy not based on sample use) OR prescriber attests continuation is appropriate and patient is at risk if therapy is changed