Vivjoa — United Healthcare

Preferred products

• fluconazole

Initial criteria

• Diagnosis of recurrent vulvovaginal candidiasis
• Patient is not of reproductive potential (i.e., biological female who is postmenopausal or has another reason for permanent infertility such as tubal ligation, hysterectomy, salpingo-oophorectomy)
• Other causes (including but not limited to bacterial vaginosis or trichomoniasis) have been ruled out
• Failure of a maintenance course of oral fluconazole defined as 100-mg, 150-mg, or 200-mg taken weekly for 6 months (Connecticut, Kentucky, and Mississippi only require a 30‑day trial)
• Prescribed by or in consultation with an infectious disease physician OR obstetrician/gynecologist

Approval duration

4 months