Brexafemme (ibrexafungerp) — United Healthcare
recurrent vulvovaginal candidiasis (RVVC)
Preferred products
- fluconazole
Initial criteria
- Diagnosis of recurrent vulvovaginal candidiasis (RVVC)
- AND One of the following:
- — Confirmed azole resistance demonstrated by culture and susceptibility testing
- OR Both of the following:
- — Other causes (including but not limited to bacterial vaginosis or trichomoniasis) have been ruled out
- AND — Failure of a maintenance course of oral fluconazole defined as 100-mg, 150-mg, or 200-mg taken weekly for 6 months (for Connecticut, Kentucky, and Mississippi business, only a 30 day trial required)
- AND Prescribed by or in consultation with one of the following:
- — Infectious disease physician
- — Obstetrician/Gynecologist
Approval duration
6 months