Myfembree (relugolix, estradiol, and norethindrone acetate tablets) — Cigna

Initial criteria

• Patient is age ≥ 18 years AND
• Patient is premenopausal (before menopause) AND
• Patient has previously tried ONE of the following unless contraindicated: (i) a contraceptive (e.g., combination oral contraceptives, levonorgestrel-releasing intrauterine systems [e.g., Mirena, Liletta], depo-medroxyprogesterone injection) OR (ii) an oral progesterone (e.g., norethindrone tablets) AND
• An exception to the prior therapy requirement can be made if the patient has previously used a gonadotropin-releasing hormone agonist (e.g., Lupron Depot [leuprolide depot injection]) or Orilissa (elagolix tablets)

Approval duration

up to 24 months