Myfembree — CareFirst (Caremark)

Initial criteria

• Patient is premenopausal
• Patient has not received the maximum recommended treatment course of 12 months of Lupron Depot or Lupaneta Pack OR 6 months of Synarel or Zoladex
• If the patient has previously received treatment with an elagolix-containing product (e.g., Oriahnn, Orilissa) or a relugolix-containing product (e.g., Myfembree), the patient must not have already received ≥ 24 cumulative months of treatment with elagolix-containing and/or relugolix-containing products (e.g., Oriahnn, Orilissa, Myfembree)
• If the patient has previously received Orilissa 200 mg twice daily, the patient must not have already received ≥ 6 months of treatment at that dose

Approval duration

Variable based on prior cumulative therapy; total additive duration not to exceed 24 months (e.g., 12 months if no prior treatment, reduced proportionally if prior elagolix/relugolix therapy)