VA CFU Criteria Formulary Advisor Reference
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ESTRADIOL PATCH

Generic Name
ESTRADIOL PATCH
Brand Names
CLIMARA, DOTTI, ESTRADIOL (ONCE WEEKLY), ESTRADIOL (TWICE WEEKLY), LYLLANA, MENOSTAR, MINIVELLE, VIVELLE-DOT
Drug Class
ESTROGENS
Formulary Status
Y
Copay Tier
2
Last Updated
2017-02-27

Clinical Criteria Summary

Systemic Hormonal Menopausal Therapy (Oral Estrogen Combinations)

  • Dosing Criteria: 0.45 mg conjugated equine estrogens/20 mg bazedoxifene daily
  • Clinical Use Criteria: Bazedoxifene is an alternative to progestin for patients with a uterus
  • Systemic Estrogen Formulary Requirements:
  • Prescribe the lowest effective dose of estrogen
  • Product selection should consider patient symptoms, risk-benefit profile, and patient preference
  • A progestin (or bazedoxifene alternative) must be prescribed for all patients with an intact uterus receiving systemic estrogen to reduce endometrial hyperplasia and cancer risk

Source Documents

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