ANNOVERA (segesterone acetate/ethinyl estradiol)


SELF ADMINISTRATION


Indications for Prior Authorization:
  • Indicated for use by females of reproductive potential to prevent pregnancy

  • Limitations: not adequately evaluated in females with a BMI >29 kg/m2

Patients must meet the following criteria for the indication(s) above:
  • Prescribed for prevention of pregnancy, AND

  • Trial and failure of two formulary contraceptive alternatives, unless contraindicated or adverse effects are experienced, AND

  • Trial and failure of Nuvaring®, AND

  • Patient does not have a contraindication to treatment:

    • High risk of arterial or venous thrombotic diseases

    • Current or history of breast cancer or other estrogen- or progestin-sensitive cancer

    • Liver tumors, acute hepatitis, or severe (decompensated) cirrhosis

    • Undiagnosed abnormal uterine bleeding

    • Hypersensitivity to any of the components of Annovera™

    • Use of Hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir

Dosing:
  • Insert 1 Annovera™ ring and leave in place for 3 weeks, followed by a 1-week system-free interval

  • One Annovera™ system provides contraception for 13 cycles

Approval:
  • 1 year (Max: 1 ring per year)

Last review date: October 15, 2019