etonogestrel/ethinyl estradiol (NuvaRing) — United Healthcare
History of Pelvic Inflammatory Disease (PID)
Initial criteria
- Patient is using the medication for non-contraception purposes (see listed examples)
Reauthorization criteria
- Reauthorization may be based on previous claim/medication history, diagnosis codes (ICD10) and/or claim logic per program rules
Approval duration
12 months