Azmiro — Medical Mutual

Initial criteria

• The patient has had persistent signs and symptoms (for example, depressed mood, decreased energy, progressive decrease in muscle mass, osteoporosis, loss of libido) of androgen deficiency (pre-treatment); AND
• The patient has had two pre-treatment serum testosterone measurements, each taken in the morning on two separate days, and both levels were low, as defined by the normal laboratory reference values.

Reauthorization criteria

• Prior to treatment, the patient has had persistent signs and symptoms (for example, depressed mood, decreased energy, progressive decrease in muscle mass, osteoporosis, loss of libido) of androgen deficiency; AND
• The patient has had at least one total serum testosterone level within the last 6 months within or below the normal limits of the reporting lab OR one total serum testosterone level beyond the normal limits despite a dose adjustment.

Approval duration

1 year