ADDYI (flibanserin)

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