Intrarosa (prasterone) — United Healthcare
moderate to severe dyspareunia due to vulvar and vaginal atrophy (VVA) due to menopause
Preferred products
- Imvexxy (estradiol)
- Osphena (ospemifene)
- Premarin vaginal cream
Initial criteria
- Diagnosis of moderate to severe dyspareunia
- AND Patient has vulvar and vaginal atrophy due to menopause
- AND History of failure, contraindication, or intolerance to two of the following: Imvexxy (estradiol) OR Osphena (ospemifene) OR Premarin vaginal cream
Reauthorization criteria
- Documentation of positive clinical response to therapy
Approval duration
12 months