Diagnosis: Heavy irregular bleeding.
Treatment: Oriahnn 300-1-0.5 and 300 mg (milligrams) OR (oral route).

The insurer denied coverage for Oriahnn 300-1-0.5 and 300 mg OR (oral route).

The denial is overturned.

The patient is a female with complaint of heavy irregular bleeding. She has tried oral contraceptives and Depo-Provera for months with no control of her bleeding. She had an endometrial biopsy that showed proliferative changes. Ultrasound showed multiple myomas both intramural and submucosal as well as thickened endometrial lining.

The provider recommended Oriahnn and tranexamic acid.

This patient is having heavy abnormal bleeding probably due to fibroids. There are multiple treatment options for this patient. The patient can be treated with surgery, a gonadotropin releasing hormone (GnRH) agonist like Depot Lupron Tranexamic acid, endometrial ablation or a GnRH agonist like Oriahnn.

Oriahnn is a combination of elagolix, a GnRH receptor antagonist, estradiol, an estrogen, and norethindrone acetate, a progestin, indicated for the management of heavy menstrual bleeding associated with uterine leiomyomas (fibroids) in premenopausal women.

This patient is premenopausal, and has heavy vaginal bleeding associated with her fibroids. Oriahnn is indicated and approved for her condition.

The health care plan did not act reasonably and with sound medical judgment and in the best interest of the patient.

The insurer's denial of coverage for the Oriahnn 300-1-0.5 and 300 mg OR is overturned. Medical Necessity is substantiated.