Brexafemme (ibrexafungerp) — Blue Cross Blue Shield of Texas

Initial criteria

• Patient is an adult or post-menarchal pediatric patient
• AND ONE of the following: (a) Diagnosis of vulvovaginal candidiasis (VVC) OR (b) BOTH: (1) Using agent to reduce incidence of recurrent vulvovaginal candidiasis (RVVC) AND (2) ≥2 episodes of VVC within 12 months
• AND ONE of the following: (a) BOTH: patient has stage IV advanced, metastatic cancer AND requested agent used for cancer or associated condition consistent with best practices and FDA approved OR (b) patient has tried and had inadequate response to fluconazole OR (c) patient has intolerance/hypersensitivity to fluconazole OR (d) patient has FDA labeled contraindication to fluconazole
• OR patient has another FDA labeled indication for the requested agent and route of administration
• OR patient has another indication supported in compendia for the requested agent and route of administration
• AND patient has no FDA labeled contraindications to the requested agent

Approval duration

BCBSIL and BCBSMT: 6 months; others: VVC 3 months, RVVC 6 months, other 6 months; Ohio Fully Insured/HIM Shop: 12 months