ADDYI (flibanserin)
ORAL ADMINISTRATION
Indications for Prior Authorization:
Hypoactive sexual desire disorder
- Treatment of premenopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD), as characterized by low sexual desire that causes marked distress or interpersonal difficulty and is not due to a coexisting medical or psychiatric condition, problems within the relationship, or the effects of a medication or other drug substance
Limitations of use
- Flibanserin is not indicated for the treatment of HSDD in postmenopausal women or in men, or to enhance sexual performance
All of the following must be met as a condition(s) for coverage:
- Treatment of premenopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD), as characterized by low sexual desire that causes marked distress or interpersonal difficulty AND
- Diagnosis is supported by medical record/chart note documentation AND
- HSDD is not due to a coexisting medical or psychiatric condition, problems within the relationship, or the effects of a medication or other drug substance AND
- patient is not taking a moderate or strong CYP3A4 Inhibitor (contraindication) concomitantly, is not using alcohol concomitantly, or does not have hepatic impairment
This Medication is Not Approvable for the following condition(s):
- Any condition not listed above as an approved indication
- Not approvable with concomitant use of alcohol or CYP3A4 inhibitors (contraindication), or for patients with hepatic impairment
Dosing:
- Females (premenopausal): 100 mg once daily at bedtime
Last review date: July 24, 2016