S0126 Insurance Policy Changes

Follitropins and Menotropins (CPB 1082, reviewed 2026-10-09)

Aetna's CPB 1082 policy on follitropins and menotropins was reviewed on 2026-10-09, establishing medical necessity criteria for injectable fertility medications in commercial plans. The policy requires precertification for Follistim AQ, Gonal-F, Gonal-F RFF, and Menopur, and outlines specific clinical criteria for coverage including prior treatment failures, age thresholds (37+), poor ovarian response risk factors, and contraindications to oral agents. Billing teams must verify precertification requirements and ensure claims align with documented clinical criteria.