Orilissa — Medical Mutual

Reauthorization criteria

• Patient is age ≥ 18 years; AND
• Patient has moderate to severe pain; AND
• Prescribed by or in consultation with an obstetrician, gynecologist, or reproductive endocrinologist; AND
• Provider will continue monitor for decreases in bone mineral density if clinically appropriate; AND
• Patient is experiencing a beneficial response to therapy with a decrease in pain and less analgesic medication usage per provider; AND
• The patient has used Orilissa for a total treatment duration of less than 24 months.

Approval duration

6 months (maximum total approval 24 months)