Oriahnn (elagolix, estradiol, and norethindrone acetate capsules; elagolix capsules – AbbVie) — Cigna

Initial criteria

• Patient age ≥ 18 years; AND
• Patient is premenopausal (before menopause); AND
• Patient is experiencing heavy menstrual bleeding associated with uterine fibroids; AND
• Uterine fibroids have been confirmed by pelvic ultrasound (including transvaginal ultrasonography or sonohysterography), hysteroscopy, or magnetic resonance imaging; AND
• Patient has tried at least one other therapy for the medical management of heavy menstrual bleeding (e.g., combination estrogen-progestin contraceptives [oral tablets, vaginal ring, transdermal patch], levonorgestrel-releasing intrauterine system [e.g., Mirena, Liletta], oral progesterone [e.g., medroxyprogesterone acetate], depo-medroxyprogesterone injection, tranexamic acid tablets); AND
• Patient has not previously received a continuous regimen of 24 months or longer of therapy with Oriahnn or Myfembree; AND
• Medication is prescribed by or in consultation with an obstetrician-gynecologist or a health care practitioner who specializes in the treatment of women’s health.

Approval duration

up to 24 months