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The Policy VaultThe Policy Vault

Synarel — Medica

Endometriosis

Initial criteria

  • Patient is age ≥ 18 years; AND
  • Patient has tried ONE of the following, unless contraindicated: (i) a contraceptive (e.g., combination oral contraceptives, levonorgestrel-releasing intrauterine system), OR (ii) an oral progesterone (e.g., norethindrone tablets), OR (iii) a depo-medroxyprogesterone injection; AND
  • Exception: Requirement for a trial of the above therapies is waived 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