Phexxi (lactic acid, citric acid, and potassium bitartrate) vaginal gel — United Healthcare
prevention of pregnancy
Preferred products
- Depo-Provera
- norethindrone (generic Micronor)
- Yaz
- Twirla
- Xulane
- Annovera
- NuvaRing
- Diaphragm
- Today
- FemCap
- Female Condom
- nonoxynol-9 based spermicide
Initial criteria
- Used for the prevention of pregnancy
- Patient is unable to use other methods of contraception due to failure, contraindication, intolerance or refusal (Examples include: Injection [e.g., Depo-Provera], Oral Contraceptive [e.g., norethindrone (generic Micronor), Yaz], Transdermal Patch [e.g., Twirla, Xulane], Vaginal Contraceptive Ring [e.g., Annovera, NuvaRing], Diaphragm, Sponge [e.g., Today], Cervical Cap [e.g., FemCap], Female Condom)
- History of failure, contraindication, or intolerance to nonoxynol-9 based spermicide
- Provider attests they have counseled the patient regarding a higher rate of pregnancy prevention with other methods of contraception (e.g., injection, oral contraception, transdermal patch, vaginal ring) compared to Phexxi
Approval duration
12 months