Oriahnn (elagolix/estradiol/norethindrone acetate) — CareFirst (Caremark)
Management of heavy menstrual bleeding associated with uterine leiomyomas (fibroids) in premenopausal women
Initial criteria
- Patient is premenopausal
- Requested drug is being prescribed for management of heavy menstrual bleeding associated with uterine leiomyomas (fibroids)
- 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 any of the following:
- • ≥ 24 cumulative months of treatment with elagolix-containing products (e.g., Oriahnn, Orilissa) and/or relugolix-containing products (e.g., Myfembree)
- • ≥ 6 months of treatment with Orilissa 200 mg twice daily
Approval duration
Total additive duration up to 24 months: authorization period depends on cumulative months of prior treatment (0–23 months) per policy table