Vivjoa (oteseconazole) — Blue Cross Blue Shield of Oklahoma

Initial criteria

• ONE of the following:
• A. ALL of the following: The patient has a diagnosis of recurrent vulvovaginal candidiasis (RVVC) AND The patient has experienced ≥ 2 episodes of VVC within a 12-month period AND ONE of the following:
• A. BOTH of the following: The patient has been diagnosed with stage IV advanced, metastatic cancer AND The requested agent use is consistent with best practices, evidence-based literature, and FDA approval for stage IV advanced metastatic cancer or an associated condition; OR
• B. The patient will be using fluconazole in combination with the requested agent OR
• C. The patient has tried and had an inadequate response to fluconazole OR
• D. The patient has an intolerance or hypersensitivity to fluconazole OR
• E. The patient has an FDA labeled contraindication to fluconazole;
• B. The patient has another FDA labeled indication for the requested agent and route of administration OR
• C. The patient has another indication that is 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

Approval duration

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