Limited Use Note(s)

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Reason For Use CodeClinical Criteria
432For the management of pelvic pain associated with endometriosis in patients for whom one or more less costly options are either ineffective or cannot be used. Note: For example for patients who are refractory to 6 months of continuous combined oral contraceptives and/or medroxyprogesterone therapy OR have contraindications to these therapies.
LU Authorization Period: 1 year