Osphena (ospemifene) — United Healthcare
Treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy due to menopause
Initial criteria
- If benefit design covers medications to treat sexual dysfunction: Diagnosis of one of the following: AND
- Treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy due to menopause OR
- Treatment of moderate to severe vaginal dryness, a symptom of vulvar and vaginal atrophy (VVA) due to menopause
- If benefit design excludes medications to treat sexual dysfunction: Treatment of moderate to severe vaginal dryness, a symptom of VVA due to menopause
Reauthorization criteria
- Documentation of positive clinical response to therapy
Approval duration
12 months