Oriahnn — Highmark
Uterine leiomyomas (fibroids) with heavy menstrual bleeding
Initial criteria
- age ≥ 18 years
- diagnosis of uterine leiomyomas (ICD-10: D25)
- premenopausal woman
- prescriber attests that the member is not pregnant if of childbearing age
- member is experiencing heavy menstrual bleeding
- no diagnosis of osteoporosis
- therapeutic failure or intolerance to at least one prior treatment to reduce menstrual bleeding (IUD, oral contraceptives, tranexamic acid) OR contraindication to all
- total combined treatment duration with Oriahnn, Orilissa, and Myfembree has not exceeded 24 months
Reauthorization criteria
- continues to experience heavy menstrual bleeding
- prescriber attests there has been a decrease in menstrual blood loss from baseline
- prescriber attests that the benefit of treatment exceeds the risk of bone loss
- total combined treatment duration with Oriahnn, Orilissa, and Myfembree has not exceeded 24 months
- prescriber attests that the member is not pregnant if of childbearing age
Approval duration
initial up to 6 months; reauthorization up to 18 months (total combined ≤ 24 months)