Oriahnn — 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 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 Oriahnn or Myfembree; 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

• Patient has not exceeded a total of 24 months of therapy with Oriahnn or Myfembree
• Response to therapy is documented

Approval duration

initial: 12 months; reauth: 12 months; maximum total 24 months