Triptodur® (triptorelin extended-release suspension)
EVICORE-MEDICAL_DRUG-FC5B1FE3
Triptodur (triptorelin ER) is covered only for pediatric patients ≥2 years with central precocious puberty and as an approved off‑label compendial use for gender‑dysphoric/gender‑incongruent individuals or those undergoing gender reassignment; other uses are not covered. Coverage requires documentation of the diagnosis (and age ≥2 for CPP), prescription by or in consultation with an endocrinologist or a physician specializing in transgender care, supporting rationale/compendial references for off‑label use, adherence to applicable safety criteria, and authorization is for up to 12 months with recommended dosing 22.5 mg IM every 24 weeks.
"For CPP: documentation of patient age (at least 2 years of age) to support the FDA-approved indication."
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