Slynd (drospirenone) 4 mg tablet — Coverage Criteria
Customize your policy alerts
Sign up for all Neighborhood Health Plan of Rhode Island policy alerts
Know when Neighborhood Health Plan of Rhode Island releases new policies or updates existing guidance.
Monitor payer policy activity
Covers authorization and coverage criteria for Slynd (drospirenone) 4 mg tablets as a contraceptive for members of Neighborhood Health Plan of Rhode Island under the pharmacy benefit.
No material clinical or coverage changes in this revision.
Coverage Criteria
Initial Therapy
Covered when ONE of the following is met:
Documentation or an adjudicated paid claim may be used to confirm prior therapy
Provider attestation must be present in the request
Use of Slynd (drospirenone) 4 mg tablet for investigational purposes is not covered. Neighborhood Health Plan of Rhode Island defines investigational use as therapies administered at a dose or for a condition that is not a medically accepted indication according to standard compendia (AHFS‑DI, Micromedex DrugDex, Clinical Pharmacology, Lexi‑Drugs) or peer‑reviewed medical literature. Claims for Slynd that represent investigational dosing or indications should be denied as not covered.
Initial Authorization Criteria
Initial Therapy — detailed initial authorization criteria
Initial authorization criteria
See step therapy coding logic: an adjudicated paid claim for norethindrone 0.35 mg or OTC Opill 0.075 mg through the pharmacy benefit satisfies the prior-therapy requirement
Continuation and Duration
Continuation/Duration
Coverage duration and continuation rules
Reauthorization requirements not specified
Step Therapy Requirements
| Step | Requirement | Coverage effect |
|---|---|---|
| 1 | Evidence of at least one paid claim for formulary norethindrone 0.35 mg tablet or OTC Opill (norgestrel) 0.075 mg tablet through the pharmacy benefit | Satisfies step therapy requirement; member may be eligible for coverage of Slynd per prior authorization criteria |
Provider Actions & Documentation
Prior Authorization Required
Prior authorization is required. Prior authorization requires documentation of the specified trial or a provider attestation as described under Required Medical Information.
- Prior authorization required for Slynd (drospirenone) 4 mg tablet.
- Provider must submit documentation of prior trial or provider attestation per policy.
Prior Therapy Required / Documentation
Provider must attest that the member has trialed and experienced an inadequate response or intolerance to formulary norethindrone 0.35 mg tablet or OTC Opill (norgestrel) 0.075 mg tablet, OR attest that other progesterone‑only contraceptives are not appropriate or not expected to have the desired response. Failure to document prior trial and inadequate response or intolerance may result in denial.
- Required attestation of trial and inadequate response or intolerance to formulary norethindrone 0.35 mg or OTC Opill 0.075 mg.
- Alternative: provider attests other progesterone‑only contraceptives are not appropriate or not expected to be effective.
Step Therapy Coding Logic
Step therapy operational billing rule: Slynd will pay if there is at least one paid claim for formulary norethindrone 0.35 mg tablet or OTC Opill 0.075 mg processed through the pharmacy benefit.
- At least one paid pharmacy claim for formulary norethindrone 0.35 mg tablet or OTC Opill (norgestrel) 0.075 mg satisfies step therapy requirement.
Drugs Referenced / Coding
| drospirenone 4mg | Slynd (drospirenone) 4 mg tablet |
| norethindrone 0.35mg | formulary norethindrone 0.35 mg tablet (required trial) |
| norgestrel 0.075mg | OTC Opill (norgestrel) 0.075 mg tablet (acceptable trial) |
Background
Slynd (drospirenone) is a progestin-only oral contraceptive option available as a 4 mg tablet. This policy addresses coverage under the pharmacy benefit for Slynd and requires either a documented trial with inadequate response or intolerance to an alternative progestin (formulary norethindrone 0.35 mg tablet or OTC Opill 0.075 mg [norgestrel]) or a provider attestation that other progesterone-only contraceptives are not appropriate or unlikely to achieve the desired response.
Prior authorization is required and must include the required medical information described above. Approved authorizations are issued for a duration of 12 months. For step‑therapy verification, an adjudicated paid pharmacy claim for formulary norethindrone 0.35 mg tablet or OTC Opill 0.075 mg satisfies the prior‑trial requirement.
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.