Histrelin Acetate (Supprelin®LA)

By September 30, 2026: Billing team must implement prior authorization requirements for all Histrelin Acetate (Supprelin LA) claims. Specific actions: (1) Update billing system to require prior auth for four covered indications: central precocious puberty (12-month auth), gender dysphoria (12-month auth), preservation of ovarian function (3-month auth), and prevention of recurrent menstrual-related attacks in acute porphyria (12-month auth); (2) Create intake documentation checklist requiring: for CPP—GnRH agonist test results or LH assay documentation; for gender dysphoria—diagnosis confirmation, Tanner stage documentation, informed consent, comorbidity status, and fertility preservation counseling documentation; for ovarian preservation—premenopausal status and active chemotherapy confirmation; (3) Configure system to enforce prescriber specialty restrictions: gender dysphoria requires pediatric endocrinologist, family/internal medicine, or OB-GYN with mental health collaboration for members under 18; porphyria requires porphyria management experience; (4) Set authorization limits: initial CPP and gender dysphoria/12 months, ovarian preservation/3 months, porphyria/12 months; continuation requires meeting all criteria without treatment failure; (5) Flag all requests outside these four indications as experimental/investigational (non-covered); (6) Update provider communication materials regarding age restrictions for gender dysphoria per Tennessee state regulatory guidelines per TCA 56-7-2352. Prior authorizations processed without complete documentation will be delayed or denied.