Brexafemme (ibrexafungerp) — Blue Cross Blue Shield of Illinois

Initial criteria

• Patient is an adult or post-menarchal pediatric patient AND has a diagnosis of vulvovaginal candidiasis (VVC) OR BOTH of the following: (1) patient is using requested agent to reduce incidence of recurrent vulvovaginal candidiasis (RVVC) AND (2) patient has experienced ≥ 2 episodes of VVC within 12 months
• AND ONE of the following applies: (A) patient has stage IV advanced, metastatic cancer and requested agent is being used to treat the cancer or an associated condition consistent with best practices supported by FDA approval and evidence-based literature; OR (B) patient has tried and had inadequate response to fluconazole; OR (C) patient has intolerance or hypersensitivity to fluconazole; OR (D) patient has an FDA labeled contraindication to fluconazole; OR (E) patient has another FDA labeled indication for requested agent and route; OR (F) patient has another compendia-supported indication for agent and route
• Patient does NOT have any FDA labeled contraindications to the requested agent

Approval duration

3 months (VVC); 6 months (RVVC or other indications); 6 months BCBSIL/BCBSMT; 12 months if Ohio Fully Insured or HIM Shop