Leuprolide Acetate (Fensolvi®, Lupron Depot- PED®, Lupron Depot®)

Fensolvi, Lupron Depot‑PED, and Lupron Depot are covered for specified non‑oncology indications (Fensolvi and Lupron Depot‑PED for central precocious puberty and select gender‑affirming uses; Lupron Depot for endometriosis, uterine leiomyomata including preoperative anemia with iron, abnormal uterine bleeding, and approved compendial off‑label uses); oncology indications are excluded. Coverage requires product‑specific age/dosing limits (e.g., Fensolvi ≥2 years), documentation of the FDA‑approved or compendial diagnosis, prescriber/consultation by an endocrinologist or transgender‑care specialist for gender‑affirming use, prior trial/failure (or contraindication) of contraceptive/oral progesterone/depo‑MPA/another GnRH agonist or a GnRH antagonist for Lupron Depot fibroids/endometriosis/abnormal uterine bleeding, and specified approval durations (Fensolvi/Lupron Depot‑PED 12 months; Lupron Depot 3–12 months by indication).

"Coverage guideline: Lupron Depot — approval for uterine leiomyomata (fibroids)."