Vyleesi (bremelanotide) is considered a sexual dysfunction drug and is the first specialty drug in this category. It is the second drug approved by the U.S. Food and Drug Administration (FDA) to treat acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women.
Vyleesi is an injectable drug with a dose limit of one dose within 24 hours and no more than eight doses per month. The average cost of Vyleesi for a cash-paying customer is $237 per dose.1 The average cost per year would vary depending on use, but could exceed $22,000.1
When coverage of sexual dysfunction drugs either are available through plan design or elected coverage (lifestyle benefit), Vyleesi will require prior authorization to confirm that the use is consistent with the FDA-approved indication and available clinical evidence.
Vyleesi will also be subject to quantity limitations (eight doses per month) consistent with the FDA-recommended dosing. When covered, the formulary tier for Vyleesi depends on the client’s plan design. If the Cigna formulary used by the client does not have a specialty tier, Vyleesi is placed on the Non-Preferred Brand Drug tier. If, however, the Cigna formulary used by the client offers a specialty drug tier, then Vyleesi is placed on the Specialty Drug tier.
Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. Some plans require use an in-network pharmacy for prescriptions to be covered. Coverage is subject to any plan deductible, copayment and/or coinsurance requirements. Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and complete details of prescription drug coverage, contact a Cigna representative.
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