Leuprolide acetate (Fensolvi, Lupron Depot-PED, Lupron Depot)_Non-onc

Leuprolide acetate (Fensolvi, Lupron Depot‑PED, Lupron Depot) is covered only for specified non‑oncology indications—CPP (Fensolvi, Lupron Depot‑PED), endometriosis, uterine fibroids (including preoperative anemia with iron), abnormal uterine bleeding, severe refractory premenstrual disorders (age ≥18), and approved compendial use for gender dysphoria/gender‑affirming care; other off‑label uses are excluded. Coverage requires documentation of the diagnosis, adherence to product‑specific age, dosing and approval‑duration limits, required prior‑therapy trials for endometriosis and premenstrual disorders, and prescriber/consultation by an endocrinologist or transgender‑care specialist for gender‑dysphoria requests.

"Lupron Depot: premenstrual disorders, including premenstrual syndrome and premenstrual dysphoric disorder."

Sign up to see full coverage criteria, indications, and limitations.