Orilissa 200 mg (elagolix) — United Healthcare
moderate to severe pain associated with endometriosis
Initial criteria
- Diagnosis of moderate to severe pain associated with endometriosis
- Failure after a 3-month trial (e.g., inadequate pain relief), contraindication, or intolerance of two analgesics (e.g., ibuprofen, meloxicam, naproxen)
- Failure after a 3-month trial, contraindication, or intolerance to one of the following: hormonal contraceptives OR progestins [e.g., norethindrone (generic Aygestin)]
- Prescribed by or in consultation with an Obstetrician/Gynecologist (OB/GYN) OR reproductive endocrinologist
Approval duration
6 months (maximum treatment duration 6 months)