Addyi (flibanserin) — United Healthcare

Initial criteria

• Diagnosis of acquired, generalized hypoactive sexual desire disorder (HSDD) OR female sexual interest/arousal disorder
• Symptoms have persisted for at least 6 months
• Low sexual desire is NOT due to a co-existing medical or psychiatric condition, problems within the relationship, or the effects of a medication or other drug substance
• Patient was female at birth
• Patient is premenopausal
• Patient does not have hepatic impairment (e.g., a Child-Pugh score of 6 points or greater)
• Patient is not concomitantly on moderate or strong CYP3A4 inhibitors (e.g., ciprofloxacin, clarithromycin, diltiazem, fluconazole, itraconazole, ketoconazole, ritonavir, verapamil)

Reauthorization criteria

• Documentation of positive clinical response to Addyi therapy
• Patient continues to be premenopausal
• Patient does not have hepatic impairment (e.g., a Child-Pugh score of 6 points or greater)
• Patient is not concomitantly on moderate or strong CYP3A4 inhibitors (e.g., ciprofloxacin, clarithromycin, diltiazem, fluconazole, itraconazole, ketoconazole, ritonavir, verapamil)

Approval duration

Initial: 3 months; Reauthorization: 12 months