Imvexxy — Medical Mutual
Moderate to severe dyspareunia resulting from vulvar and vaginal atrophy, a symptom of menopause
Initial criteria
- Patient is a post-menopausal woman with vulvar and/or vaginal atrophy; AND
- Patient has had an inadequate response to at least one low-dose vaginal estrogen preparation (e.g. generic estrogen vaginal cream, generic estrogen vaginal insert, Yuvafem, Premarin vaginal cream, Estrace vaginal cream, Estring, Vagifem); AND
- Patient does not have any contraindications to use of estrogens (e.g. history of breast cancer, estrogen-dependent neoplasia, undiagnosed abnormal genital bleeding, liver disease/impairment, history of or active DVT, PE, stroke, or MI); AND
- Imvexxy will not be used in combination with other estrogen preparations, Osphena, or Intrarosa
Reauthorization criteria
- The patient meets all the initial criteria; AND
- The patient has had an improvement on Imvexxy per the prescribing physician
Approval duration
initial: 3 months; extended: 1 year