CurrentCignaPolicy N/A

Hypoactive Sexual Desire Disorder - Addyi Prior Authorization Policy

Defines prior authorization criteria and coverage for Addyi (flibanserin) for treatment of hypoactive sexual desire disorder / female sexual interest/arousal disorder under Cigna benefit plans, including initial and continuation approval conditions and exclusion for other uses.

Policy Summary

PayerCigna

PolicyHypoactive Sexual Desire Disorder - Addyi Prior Authorization Policy

Policy CodePolicy N/A

Change Typeclarified

Effective Date

Next Review Date

Key ActionPrior Authorization is recommended for prescription benefit coverage of Addyi; approvals provided for specified durations (initial: 8 weeks; continuation: 6 months).

SourceLink

POLICY UPDATE CHANGES

Annual Revision, Summary of Changes = No criteria changes.

2Approval durations (initial, continuation)

6 monthsMinimum symptom duration required

<65Age limit for coverage

1Indication covered (HSDD/FSIAD)

Coverage Summary

Cigna coverage stance: covered_with_criteria for Addyi (flibanserin) for treatment of Hypoactive Sexual Desire Disorder (HSDD) / Female Sexual Interest/Arousal Disorder (FSIAD). Coverage is limited to women <65 years of age with symptoms that have persisted for a minimum of ≥6 months. Prior authorization is recommended and approvals are provided for specified durations: initial approval 8 weeks and continuation approval 6 months when continuation criteria are met.

Compact facts: policy defines prior authorization criteria and documentation requirements for Addyi; approvals are provided for the durations noted above and the policy was last reviewed on 01/14/2026.

Key thresholds and quick facts

Age< 65 years

Symptom duration>= 6 months

Initial approval duration8 weeks

Continuation approval duration6 months

IndicationHSDD/FSIAD (acquired, generalized)

Medical Necessity Criteria

Covered - FDA-Approved Indication

Approve for the duration noted if the patient meets ONE of the following (A or B):

A) Initial Therapy

Patient is < 65 years of age
Patient's symptoms of HSDD/FSIAD have persisted for a minimum of 6 months>= 6 months
Patient has had normal sexual desire in the past, prior to the diagnosis of HSDD/FSIAD
Patient does not have a diagnosis of depression
Other known causes of HSDD/FSIAD (co-existing medical or psychiatric conditions, relationship problems, medication effects such as antidepressants, or drug abuse) have been ruled out by the prescriber
The prescriber has counseled the patient regarding the interaction with alcohol and Addyi, and the increased risk of hypotension and syncope
Authorization duration: Approve for 8 weeks

B) Patient is Currently Receiving Addyi

Patient is < 65 years of age
The prescriber confirms that since initiating Addyi therapy, the patient reports a significant improvement in sexual desire and/or a decrease in sexual distress
Patient has not reported any serious or concerning adverse events (e.g., hypotension, syncope, dizziness) while taking Addyi
Authorization duration: Approve for 6 months

Not Medically Necessary / Exclusions

Not covered when criteria are not met:

Addyi (flibanserin tablets) is considered not medically necessary for ANY other use(s) beyond the specified HSDD/FSIAD indication

Provider Actions & Requirements

Prior Authorization

Prior authorization required

Prior authorization is recommended for prescription benefit coverage of Addyi. Approvals are provided for specified durations: initial approvals for 8 weeks and continuation approvals for 6 months.

Documentation Required

Clinical documentation to support diagnosis and exclusions

Prescriber must document: diagnosis of HSDD/FSIAD; symptom duration of at least 6 months; prior normal sexual desire; absence of a diagnosis of depression; that other causes (co-existing medical or psychiatric conditions, relationship problems, medication effects such as antidepressants, or drug abuse) have been ruled out; and counseling provided about the interaction with alcohol and the increased risk of hypotension and syncope.

Diagnosis: HSDD/FSIAD
Symptom duration ≥ 6 months
History of prior normal sexual desire
No diagnosis of depression
Other causes ruled out (medical/psychiatric conditions, relationship problems, medication effects, drug abuse)
Counseled about alcohol interaction and increased risk of hypotension and syncope

Documentation Required

Continuation documentation

For continuation approval the prescriber must confirm that since initiating Addyi therapy the patient reports a significant improvement in sexual desire and/or decreased sexual distress, and that the patient has not reported any serious or concerning adverse events (e.g., hypotension, syncope, dizziness) while taking Addyi.

Denial Risk

Discontinue if no improvement

Per the prescribing information and policy, therapy should be discontinued after 8 weeks if the patient does not report improvement; continuation approvals require a reported benefit.

Discontinue Addyi after 8 weeks if no reported improvement
Continuation approvals require patient-reported benefit

Background, Evidence & Definitions

Addyi (flibanserin) is FDA indicated for treatment of acquired, generalized HSDD in women <65 years characterized by low sexual desire causing marked distress and not due to medical/psychiatric conditions, relationship problems, or medication/substance effects. The prescribing information recommends that Addyi be discontinued after 8 weeks if the patient does not report improvement in HSDD symptoms.

Addyi carries a Boxed Warning regarding concomitant alcohol use, which increases the risk of severe hypotension and syncope; patients should be counseled about this interaction and advised on dosing relative to alcohol consumption.

Source	Reference
Prescribing information	Addyi tablets [Sprout], December 2025
Guideline	ACOG Practice Bulletin No.213 (2019) - discusses Addyi as option in premenopausal women without depression and notes low quality evidence

HSDD/FSIAD: Hypoactive Sexual Desire Disorder / Female Sexual Interest/Arousal Disorder is characterized by low sexual desire causing marked distress or interpersonal difficulty that is not due to a co-existing medical or psychiatric condition, relationship problems, or the effects of a medication or other drug substance.

Revision History

01/22/2025clarified

Annual Revision, Summary of Changes = For both initial and continuation criteria, the criterion related to premenopausal women was removed. Added a criterion that the patient is ˂ 65 years of age. Removed the condition not recommended for approval related to postmenopausal women.

01/14/2026reviewedLatest

Review Date updated; policy review on 01/14/2026 with no additional criteria changes noted.

01/03/2024reviewed