Triptorelin (Triptodur®)

By September 30, 2026: Billing and prior authorization teams must implement new workflow procedures for Triptorelin (Triptodur®) claims. (1) Update billing system to require prior authorization for all four covered indications: central precocious puberty, gender dysphoria, preservation of ovarian function, and prevention of recurrent menstrual-related attacks in acute porphyria. (2) For CPP requests: Require providers to submit laboratory documentation showing either pubertal response to GnRH agonist test OR pubertal basal LH level on third-generation assay, plus bone age assessment and pathologic cause evaluation before authorization. (3) For gender dysphoria: Require providers to confirm prescriber is specialized in transgender youth care with mental health collaboration for members under 18, member has reached Tanner stage 2+, comorbidities are controlled, and member informed of fertility preservation options. Authorization limited to 12 months per request. (4) For ovarian function preservation: Require confirmation member is premenopausal and undergoing chemotherapy; authorize for 3 months only. (5) For acute porphyria: Require prescriber experienced in porphyria management; authorize for 12 months. Providers must use encounter forms or billing software templates to ensure all required clinical documentation is submitted with prior authorization requests. Front desk staff should flag any Triptorelin requests before September 30, 2026 as informational only since policy does not take effect until that date. Failure to implement required prior authorization checks may result in claim denials after the effective date.