CurrentCignaPolicy IP0116

Hypoactive Sexual Desire Disorder - Addyi

Defines Cigna's coverage criteria for Addyi (flibanserin) for treating acquired, generalized hypoactive sexual desire disorder (HSDD)/female sexual interest/arousal disorder (FSIAD) in premenopausal women and specifies excluded uses.

Policy Summary

PayerCigna

PolicyHypoactive Sexual Desire Disorder - Addyi

Policy CodePolicy IP0116

Change TypeRevised criteria and counseling requirements

Effective DateThe policy effective date is in force until updated or retired.

Next Review Date

Key ActionObtain prior authorization and document premenopausal status, ≥6 months of symptoms, prior normal sexual desire, exclusion of depression/other causes, and prescriber counseling about alcohol interaction and hypotension/syncope.

SourceLink

POLICY UPDATE CHANGES

Policy title updated from Flibanserin to Hypoactive Sexual Desire Disorder - Addyi; removed 'Female at birth' from criteria and changed depression criterion wording to 'Patient does not have a diagnosis of depression.'

Added requirement that prescriber counseling specifically addresses the increased risk of hypotension and syncope with alcohol use while on Addyi.

8 weeksInitial approval duration

6 monthsApproval duration for current users reporting benefit

≥6 monthsMinimum symptom duration required prior to therapy

Boxed WarningAlcohol interaction — severe hypotension and syncope risk

2015FDA approval year referenced for Addyi

Coverage Criteria for Addyi (flibanserin)

FDA-Approved Indication

Covered when ONE of the following is met

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

A) Initial Therapy (approve 8 weeks): Patient meets all of i-vi

i. Patient is premenopausal; ii. Patient's symptoms of HSDD/FSIAD have persisted for a minimum of 6 months; iii. Patient has had normal sexual desire in the past, prior to the diagnosis of HSDD/FSIAD; iv. Patient does not have a diagnosis of depression; v. Other known causes of HSDD/FSIAD (medical/psychiatric conditions, relationship problems, medication effects, substance abuse) have been ruled out by the prescriber; vi. Prescriber has counseled the patient regarding the interaction with alcohol and Addyi and the increased risk of hypotension and syncope.

B) Patient is Currently Receiving Addyi (approve 6 months): Patient meets all of i-iii

i. Patient is premenopausal; ii. Since initiating Addyi therapy, the patient reports a significant improvement in sexual desire and/or a decrease in sexual distress; iii. Patient has not reported any serious or concerning adverse events (e.g., hypotension, syncope, dizziness) while taking Addyi.

Policy Summary

PayerCigna

PolicyHypoactive Sexual Desire Disorder - Addyi

Policy CodePolicy IP0116

Change TypeRevised criteria and counseling requirements

Effective DateThe policy effective date is in force until updated or retired.

Next Review Date

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Prior Authorization, Documentation, and Provider Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for Addyi (flibanserin). Initial approvals are for 8 weeks when initial therapy criteria are met. Patients currently receiving Addyi who meet continuation criteria may be approved for 6 months.

Prior authorization required
Initial approval: up to 8 weeks when Initial Therapy criteria met
Continuation approval: up to 6 months for patients currently receiving Addyi who meet continuation criteria

Step Therapy

No step therapy requirements are specified for Addyi in this policy.

Documentation Required

Required Documentation Elements

Documentation must clearly support the coverage criteria. Include evidence of premenopausal status, symptom duration of at least 6 months, prior normal sexual desire, exclusion of depression and other causes, counseling regarding alcohol interaction and risk of hypotension/syncope, and for continuation therapy documentation of patient-reported benefit and absence of serious adverse events.

Document patient is premenopausal
Document symptoms have persisted >= 6 months
Document prior normal sexual desire before onset of symptoms
Document no diagnosis of depression
Document that other causes (medical/psychiatric conditions, relationship issues, medication effects, substance abuse) were ruled out
Document prescriber counseling regarding alcohol interaction and increased risk of hypotension and syncope
For patients currently receiving therapy: document reported significant improvement in sexual desire and/or decreased sexual distress and no serious or concerning adverse events (e.g., hypotension, syncope, dizziness)

Denial Risk

Excluded Indications / Not Covered Uses

Use of Addyi for any indication other than covered premenopausal HSDD/FSIAD (including postmenopausal patients) is considered experimental, investigational, or unproven and is not covered.

Not covered: postmenopausal patients or any other non‑approved indications

Definitions and Safety Highlights

Addyi (flibanserin) — definition and indication summary

Drug name and active ingredientAddyi (flibanserin)

FDA‑approved indicationTreatment of acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women; not indicated for postmenopausal women or men.

Treatment goal and discontinuation guidancePrescribing information recommends discontinuation after 8 weeks if the patient does not report improvement in HSDD symptoms.

Limitations of useNot indicated to enhance sexual performance.

Alcohol interaction risk — counseling and safety details

Risk summary (boxed warning)Concurrent alcohol use increases the risk of severe hypotension and syncope (Boxed Warning).

Patient counseling timingPatients should be counseled to wait at least two hours after consuming 1–2 standard alcoholic drinks before taking Addyi.

If ≥3 drinks consumedPatients should be instructed to skip the Addyi dose if they have consumed three or more standard alcoholic drinks that evening.

Prescriber counseling requirementPrescribers must counsel patients about the alcohol interaction and the increased risk of hypotension and syncope as part of the Initial Therapy criteria and required documentation for prior authorization.

OpenPayer

Hypoactive Sexual Desire Disorder - Addyi

Coverage Criteria for Addyi (flibanserin)

Coding and Coding-Related Details

Prior Authorization, Documentation, and Provider Requirements

Background and Context

Definitions and Safety Highlights