Brexafemme (ibrexafungerp) — Blue Cross Blue Shield of Oklahoma
other FDA labeled indication
Initial criteria
- The patient is an adult or a post-menarchal pediatric patient
- AND ONE of the following:
- • The patient has a diagnosis of vulvovaginal candidiasis (VVC)
- • The patient is using the requested agent to reduce the incidence of recurrent vulvovaginal candidiasis (RVVC) AND has experienced ≥ 2 episodes of VVC within a 12-month period
- AND ONE of the following:
- • The patient has 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 use is consistent with best practices, supported by peer-reviewed literature, and FDA approved
- • The patient has tried and had an inadequate response to fluconazole
- • The patient has an intolerance or hypersensitivity to fluconazole
- • 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 supported in compendia for the requested agent and route of administration
- AND The patient does NOT have any FDA labeled contraindications to the requested agent
- Compendia Allowed: AHFS or DrugDex 1, 2a, or 2b level of evidence
- Alternate approval for Ohio residents with Fully Insured or HIM Shop plans when no contraindication and either an FDA labeled indication, compendia supported indication, or prescriber submitted two peer-reviewed journal articles supporting proposed use
Approval duration
VVC 3 months; RVVC 6 months; other 6 months; Ohio cases 12 months