UnitedHealthcare
Oriahnn (elagolix-estradiol-norethindrn)
Hormones : Drugs for Woman
  • Prior Authorization: Uterine Fibroids:
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Quantity Limit: limit maximum 2 EA PER 1 day(s)
  • Uterine Fibroids:
    Duration: 6 Month(s)
    Specialist Required: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Gynecologist;Obstetrician;Reproductive Endocrinologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    Diagnosis Requirement(s): Uterine leiomyomata
    Excluded Condition(s): Received greater than or equal to 24 months of therapy of the requested drug
    Documented Diagnosis: Yes

  • Step Therapy: Uterine Fibroids:
    ST Single Generic

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