Orilissa
Defines clinical criteria, duration limits, and quantity limits for coverage of Orilissa (elagolix) for treatment of moderate to severe endometriosis-related pain under a Medicaid scope.
Policy reviewed on 3/2026 with references updated (Orilissa package insert cited Dec 2025).
Coverage Summary
Coverage stance: covered_with_criteria for Orilissa (elagolix) for endometriosis-related pain. Scope: Medicaid; this policy defines clinical criteria requiring Orilissa to be used for moderate-to-severe endometriosis-related pain and subjects coverage to prior hormonal therapy trials, hepatic-function restrictions, and cumulative exposure/duration limits.
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