Pharmacy Prior Authorization Criteria

Veozah (fezolinetant)

Indications for Prior Authorization

Veozah (fezolinetant)

• For diagnosis of Moderate to severe vasomotor symptoms
  Indicated for the treatment of moderate to severe vasomotor symptoms due to menopause.

Criteria

Veozah

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)

• Diagnosis of moderate to severe vasomotor symptoms due to menopause
AND
• Trial and failure, contraindication, or intolerance to one of the following:
• Menopausal hormone therapy (e.g., Premarin, Bijuva, Estrogel, etc.)
• Non-hormonal therapy (e.g. paroxetine mesylate, venlafaxine, clonidine, etc.)
AND
• Prescriber attests that baseline serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST) and total bilirubin levels are less than 2 times the upper limit of normal (ULN) prior to initiating Veozah

Veozah

Prior Authorization (Reauthorization)

Length of Approval: 6 Month(s)

• Patient demonstrates positive clinical response to therapy (e.g., decrease in frequency and severity of vasomotor symptoms from baseline, etc.)
AND
• Both of the following within the past 3 months:
• Transaminase elevations are less than 5 times the ULN
• Both transaminase elevations are less than 3 times the ULN and the total bilirubin level is less than 2 times the ULN

P & T Revisions

2024-10-21, 2024-10-16, 2024-05-30, 2023-10-16, 2023-07-11

References

1. Veozah Prescribing Information. Astellas Pharma US, Inc. Northbrook, IL. August 2024.

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Revision History

• 2024-10-21: Updates to criteria based on new FDA safety communication for hepatotoxicity
• 2024-10-16: Updates to criteria based on new FDA safety communication for hepatotoxicity
• 2024-05-30: 2024 annual review. Updated reauth language to standard verbiage. No changes to clinical intent.
• 2023-10-16: Updated trial requirements
• 2023-07-11: New Program

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