Brexafemme (ibrexafungerp) — Blue Cross Blue Shield of New Mexico

Initial criteria

• Patient is an adult or post-menarchal pediatric patient
• AND ONE of the following: (a) Diagnosis of VVC OR (b) BOTH of the following: (1) Using agent to reduce incidence of RVVC AND (2) ≥ 2 episodes of VVC within 12 months
• AND ONE of the following: (a) BOTH of the following: (1) The patient has stage IV advanced metastatic cancer and agent used to treat the cancer OR associated condition AND (2) Use consistent with best practices and FDA approved indication OR (b) Tried and had inadequate response to fluconazole OR (c) Intolerance or hypersensitivity to fluconazole OR (d) FDA labeled contraindication to fluconazole OR (e) another FDA labeled indication OR (f) compendia supported indication
• Patient does NOT have any FDA labeled contraindications to the requested agent

Approval duration

3–6 months (VVC 3 mo; RVVC/other 6 mo; BCBSIL/BCBSMT 6 mo; Ohio special 12 mo)