CommercialPrior AuthMedium impact
Human Chorionic Gonadotropin
Blue Cross & Blue Shield of Mississippi·MS · Endocrinology, Urology, OB-GYN +1 more·Medical Policy
Effective date
May 26, 2026
We identified it
Jun 20, 2026
Summary
Human Chorionic Gonadotropin (HCG) policy updated to clarify that Novarel and Pregnyl require prior authorization only for hypogonadism secondary to pituitary deficiency and prepubertal cryptorchidism. The policy explicitly excludes coverage for infertility treatments and confirms that sample usage cannot satisfy medical policy requirements.
Action Required
By May 26, 2026: Billing team must ensure prior authorization is obtained for all Novarel and Pregnyl prescriptions for covered indications (hypogonadism secondary to pituitary deficiency and prepubertal cryptorchidism). Update billing system to flag HCG claims for infertility treatments as non-covered. Verify formulary coverage for each patient's specific benefit plan before billing.