Vivjoa (oteseconazole) — Blue Cross Blue Shield of Montana

Initial criteria

• ALL of the following: The patient has a diagnosis of recurrent vulvovaginal candidiasis (RVVC); The patient has experienced ≥ 2 episodes of vulvovaginal candidiasis within a 12 month period
• AND ONE of the following: The patient has been diagnosed with stage four advanced, metastatic cancer and the requested agent is being used to treat the cancer or an associated condition related to stage four advanced, metastatic cancer, and the use is consistent with best practices and supported by peer-reviewed evidence; OR The patient will be using fluconazole in combination with the requested agent; OR The patient has tried and had an inadequate response to fluconazole; OR The patient has an intolerance or hypersensitivity to fluconazole; OR The patient has an FDA labeled contraindication to fluconazole
• OR The patient has another FDA labeled indication for the requested agent and route of administration
• OR The patient has another indication that is supported in compendia for the requested agent and route of administration
• The patient does NOT have any FDA labeled contraindications to the requested agent

Approval duration

BCBSIL and BCBSMT: 6 months; all other plans: RVVC - 4 months; all other indications - 6 months