Vyleesi (bremelanotide injection) — Highmark
acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women
Initial criteria
- age ≥ 18 years
- premenopausal female
- diagnosis of acquired, generalized HSDD (ICD-10: F52.0)
- HSDD is unrelated to all of the following: co-existing medical or psychiatric condition AND problems with the relationship AND effects of a medication or drug substance
- member meets one of the following: currently enrolled in behavioral therapy for HSDD OR experienced therapeutic failure in behavioral therapy for HSDD OR not a candidate for behavioral therapy for HSDD
Reauthorization criteria
- premenopausal female
- prescriber attests member has experienced improved sexual desire from baseline
Approval duration
initial: up to 2 months; reauthorization: up to 12 months