Histrelin acetate subcutaneous implant (Supprelin LA)

Supprelin LA (histrelin acetate subcutaneous implant) is covered only for the FDA‑approved indication—treatment of children with central precocious puberty—and off‑label uses, other populations, doses, routes, or more frequent insertions are excluded. Coverage requires documentation of the CPP diagnosis in the medical record and is limited to a single 50 mg subcutaneous implant in the upper arm replaced every 12 months, with authorization limited to 12 months.

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

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