Myfembree — Medical Mutual

Initial criteria

• Patient is age ≥ 18 years; AND
• Patient is premenopausal; AND
• Patient is experiencing heavy menstrual bleeding associated with the uterine fibroids; AND
• Uterine fibroids have been confirmed by a pelvic ultrasound, including transvaginal ultrasonography or sonohysterography; hysteroscopy; or magnetic resonance imaging; AND
• Patient has tried at least one other therapy for the medical management of heavy menstrual bleeding; AND
• Patient has not previously received a continuous regimen of 24 months or longer of therapy with Myfembree or Oriahnn; AND
• Medication is prescribed by or in consultation with an obstetrician-gynecologist or a health care practitioner who specializes in the treatment of women’s health

Reauthorization criteria

• Continuation permitted if total therapy duration with Myfembree does not exceed 24 months

Approval duration

up to 24 months