Addyi (flibanserin) — Highmark
acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women
Initial criteria
- age ≥ 18 years
- member is a premenopausal female
- diagnosis of HSDD (ICD-10: F52.0)
- provider has confirmed that HSDD is unrelated to a co-existing medical or psychiatric condition, substance abuse, or relationship issue
- member meets one of the following: currently enrolled in behavioral therapy for HSDD OR has experienced therapeutic failure of behavioral therapy for HSDD OR is not a candidate for behavioral therapy for HSDD
- prescriber attests that the member does not have a current issue with alcohol or substance abuse
- prescriber attests that the member has been educated on Addyi administration including the potential adverse effects of alcohol consumption with Addyi
Reauthorization criteria
- prescriber attests that the member is tolerating therapy
- prescriber attests that the member is experiencing improved sexual desire from baseline
Approval duration
initial: up to 2 months; reauthorization: up to 12 months