Progestins (CPB 0510, reviewed 2026-07-13)
Summary
Aetna considers medroxyprogesterone acetate injection (Depo-Provera CI or generic 150 mg/mL) medically necessary for pregnancy prevention and for gender dysphoria when the listed criteria are met. It considers the etonogestrel subdermal implant (Nexplanon) medically necessary for pregnancy prevention and for primary or secondary dysmenorrhea associated with endometriosis in adolescents, and it considers progestin-releasing IUDs (Kyleena, Mirena, Skyla and Liletta) medically necessary for contraception or heavy menstrual bleeding. Progesterone intramuscular injection is medically necessary for amenorrhea or abnormal uterine bleeding due to hormonal imbalance without organic pathology, and the policy considers it experimental, investigational, or unproven for other indications, including pregnancy prevention, twin pregnancies, endometrial hyperplasia, premenstrual syndrome and stroke.
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