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Leuprolide Acetate Depot Suspension (Lupron Depot-Ped®)
Act
by Sep 30, 2026
Effective date
Sep 30, 2026
Identified
Jul 17, 2026
Summary
BlueCross BlueShield of Tennessee has established a new medical policy for Leuprolide Acetate Depot Suspension (Lupron Depot-Ped®) effective 9/30/2026, covering two indications: FDA-approved central precocious puberty (CPP) in pediatric patients and compendial use for gender dysphoria in adolescents and adults. The policy requires specific prior authorization criteria, documented laboratory confirmation for CPP, and specialized provider requirements for gender dysphoria cases, including mental health collaboration for members under 18.
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What to do
by Sep 30, 2026 · 9 steps
01Billing and clinical teams must implement prior authorization processes for all Lupron Depot-Ped® prescriptions.
02Update billing system to require prior authorization for both CPP and gender dysphoria indications, with authorization limited to 12-month periods.
03Create PA requirement documentation templates that capture: for CPP—laboratory evidence (GnRH agonist test response or third-generation LH assay results), bone age assessment, age at symptom onset, and pathologic cause assessment; for gender dysphoria—diagnosis confirmation, Tanner stage 2+ documentation, comorbidity status, informed consent records, contraindication/side effect education documentation, and fertility preservation counseling records.
04Providers must verify prescriber specialty for gender dysphoria cases (pediatric endocrinologist, family/internal medicine, or OB-GYN with mental health collaboration documented for members under 18); Route prescriptions lacking required specialization to denial.
05Implement age-based approval restrictions per Tennessee state regulatory guidelines for gender dysphoria cases.
06Configure system to enforce continuation criteria: CPP patients must be female <12 years old or male <13 years old with no treatment failure signs; gender dysphoria continuation requires diagnosis confirmation and concurrent gender-affirming hormone therapy documentation.
07Front-desk staff must screen all Lupron Depot-Ped® prescriptions to determine indication and route to appropriate PA pathway.
08Failure to obtain prior authorization or submit required documentation will result in claim denials.
09Note: Do not implement changes before 9/30/2026 per policy header.
Original notice
Leuprolide Acetate Depot Suspension (Lupron Depot-Ped®)
bcbst.com no longer serves this document. We saved a copy on Nov 6, 2026.
Related changes
See all BCBS Tennessee changes →Leuprolide Acetate Depot Suspension (Lupron Depot-Ped®)MediumEffective Dec 1, 2026 · Medical PolicyLeuprolide Acetate Depot Suspension [Lupron Depot (1 month) 7.5mg, Lupron Depot (3 month) 22.5mg, Lupron Depot (4-Month) 30 mg, Lupron Depot (6-Month) 45 mg]; Leuprolide acetate depot (3-month 22.5 mg); Lutrate Depot® (3-month 22.5 mg)HighEffective Dec 1, 2026 · Medical PolicyLeuprolide Acetate (Fensolvi®)MediumEffective Dec 1, 2026 · Medical PolicyBrowse every BCBS Tennessee change in the policy list