CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Slynd (drospirenone) 4 mg tablet — Coverage Criteria

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.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicySlynd (drospirenone) 4 mg tablet — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 1, 2026

Next Review DateApr 1, 2026

Key ActionObtain prior authorization with documentation of trial and inadequate response or intolerance to formulary norethindrone 0.35 mg tablet or OTC Opill (norgestrel) 0.075 mg tablet, or provide provider attestation that other progesterone-only contraceptives are not appropriate.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12 monthscoverage duration

prior trialstep therapy

Slynddrug-specific

Coverage Criteria

Initial Therapy

Covered when ONE of the following is met:

Primary criteria: Member has trialed and experienced an inadequate treatment response or intolerance to formulary norethindrone 0.35 mg tablet or OTC Opill (norgestrel) 0.075 mg tablettrial with inadequate response or intolerance

Documentation or an adjudicated paid claim may be used to confirm prior therapy

Alternate criteria: Provider attests other progesterone-only contraceptives are not appropriate or not expected to have the desired responseprovider attestation

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.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicySlynd (drospirenone) 4 mg tablet — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 1, 2026

Next Review DateApr 1, 2026

SourceLink

On This Page

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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

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.

Documentation Required

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

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.

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

Investigational use — definition

DefinitionTherapies used at a dose or for a condition other than those recognized as medically accepted indications according to standard compendia (AHFS-DI, DrugDex, Clinical Pharmacology, Lexi-Drugs) or peer-reviewed literature.

Coverage stanceNeighborhood does not provide coverage for drugs when used for investigational purposes.

Accepted references for determining indicationsAmerican Hospital Formulary Service Drug Information (AHFS-DI); Thomson Micromedex DrugDex; Clinical Pharmacology; Wolters Kluwer Lexi-Drugs; peer-reviewed published medical literature.

How investigational is determinedUse at a non‑recognized dose or for a non‑recognized condition across any one of the listed compendia or absence of sufficient peer‑reviewed evidence deems the use investigational.

Effect on coverageUse classified as investigational per the definition is not covered by Neighborhood Health Plan of Rhode Island.

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)

OpenPayer

Slynd (drospirenone) 4 mg tablet — Coverage Criteria

Coverage Criteria

Initial Authorization Criteria

Continuation and Duration

Step Therapy Requirements

Provider Actions & Documentation

Drugs Referenced / Coding

Background

Definitions