Addyi — Medical Mutual

Acquired, generalized hypoactive sexual desire disorder (HSDD)/female sexual interest/arousal disorder (FSIAD)

Initial criteria

Patient is a premenopausal woman; AND
Patient has a diagnosis of acquired, generalized hypoactive sexual desire disorder (HSDD)/female sexual interest/arousal disorder (FSIAD) consistent with the current version of the DSM; AND
Patient has had normal sexual desire in the past, prior to the diagnosis of HSDD/FSIAD; AND
Patient’s low sexual desire is NOT caused by any of the following: co-existing medical or psychiatric condition; problems within the relationship; the effects of medication (e.g., antidepressants) or other drug substances; drug abuse; AND
Addyi is not being used to enhance sexual performance; AND
Prescriber has counseled the patient regarding the interaction of Addyi with alcohol and the increased risk of hypotension and syncope; AND
Patient does not have hepatic impairment; AND
Patient will not use Addyi concurrently with CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin); AND
Patient will not exceed maximum recommended dose of 100 mg taken once daily at bedtime; AND
Patient is not currently pregnant or breastfeeding

Patient continues to meet all criteria for new starts; AND
Patient has been evaluated and has seen improvement on Addyi defined by an increase in satisfying sexual events, and/or improvement in sexual desire, as determined by the prescriber; AND
Patient has not reported any serious or concerning adverse events (e.g., hypotension, syncope, dizziness) while using Addyi

initial 2 months; reauth 6 months