Supprelin LA (histrelin acetate) subcutaneous implant

Supprelin LA is covered only for the FDA‑approved use—treatment of children with central precocious puberty—and non‑FDA uses are excluded. Coverage requires meeting the policy’s specific criteria, is approved for 12 months, and recommends a single 50 mg subcutaneous implant in the upper arm every 12 months, with no additional documentation specified.

"Supprelin LA (histrelin acetate subcutaneous implant) is indicated for the treatment of children with central precocious puberty."

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