Synarel (nafarelin acetate nasal solution – Pfizer) — Cigna

Initial criteria

• Patient is age ≥ 18 years; AND
• Patient has tried ONE of the following, unless contraindicated (i, ii, or iii):
• i. A contraceptive; OR
• ii. An oral progesterone (e.g., norethindrone tablets); OR
• iii. A depo-medroxyprogesterone injection.
• Note: An exception to the requirement for a trial of the above therapies can be made if the patient has previously used a gonadotropin-releasing hormone (GnRH) agonist (e.g., Lupron Depot) or antagonist (e.g., Orilissa) for endometriosis.

Approval duration

6 months