Oriahnn — United Healthcare
Uterine fibroids (leiomyomas) with heavy menstrual bleeding
Preferred products
- estrogen/progestin contraceptive (e.g. Loestrin FE)
- progestin-releasing intrauterine device (e.g. Mirena)
- progestin-only contraceptive [e.g., norethindrone (generic Micronor)]
Initial criteria
- Diagnosis of uterine fibroids (leiomyomas)
- Used for the management of heavy menstrual bleeding
- Failure after a three-month trial, contraindication, or intolerance to ONE of the following: estrogen/progestin contraceptive (e.g. Loestrin FE), progestin-releasing intrauterine device (e.g. Mirena), or progestin-only contraceptive [e.g., norethindrone (generic Micronor)]
- Prescribed by or in consultation with an Obstetrics/Gynecologist (OB/GYN) OR reproductive endocrinologist
Reauthorization criteria
- Documentation of positive clinical response to therapy
- Impact to bone mineral density has been considered
- Treatment duration has not exceeded a total of 24 months
Approval duration
12 months (up to a maximum total treatment duration of 24 months)