Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

LHRH analogs (leuprolide acetate/mesylate, goserelin, triptorelin, histrelin) are covered when used for FDA-approved indications (e.g., advanced prostate cancer, CPP, endometriosis, certain breast/ovarian/head-and-neck cancers) and per referenced NCCN guidance where cited. Coverage requires documentation of the diagnosis and adherence to the FDA-approved dosing and frequency; uses exceeding FDA-recommended doses/frequencies or in patients with documented allergy to the product or ingredients are not covered.

"Leuprolide acetate is covered for treatment of endometriosis consistent with the FDA-approved labeling."

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