Vyleesi (bremelanotide) — United Healthcare

Initial criteria

• Diagnosis of one of the following: (1) Acquired, generalized hypoactive sexual desire disorder (HSDD) OR (2) Female sexual interest/arousal disorder
• Symptoms of HSDD or female sexual interest/arousal disorder have persisted for at least 6 months
• Low sexual desire is NOT due to any of the following: (1) A co-existing medical or psychiatric condition, (2) Problems within the relationship, (3) The effects of a medication or other drug substance
• Patient was female at birth
• Patient is premenopausal
• Patient does not have uncontrolled hypertension
• Patient does not have known cardiovascular disease

Reauthorization criteria

• Documentation of positive clinical response to Vyleesi therapy
• Patient continues to be premenopausal

Approval duration

Initial: 2 months; Reauthorization: 12 months