Leuprolide Acetate (Fensolvi®)

By October 30, 2026: Billing and clinical teams must prepare for policy implementation. (1) Update prior authorization protocols in billing system to require authorization for Fensolvi claims for CPP and gender dysphoria indications. (2) Create templates to collect required documentation: for CPP—GnRH agonist test results or third-generation LH assay values, bone age assessment, and pathologic cause evaluation; for gender dysphoria—diagnosis documentation, Tanner stage, comorbidity status, patient education records, and fertility preservation counseling documentation. (3) Establish prescriber verification process to confirm specialized credentials (pediatric endocrinologist, family medicine, internal medicine, OB-GYN for gender dysphoria cases; pediatric endocrinologist or specialist for CPP). For gender dysphoria cases with members under 18, verify collaborative care with mental health provider. (4) Update claim denial protocols to reject non-compliant claims with specific denial reasons. (5) Brief providers on new requirements and documentation expectations. Failure to obtain prior authorization or submit required documentation will result in claim denials. Note: Policy applies only to BlueCross BlueShield of Tennessee and only after 10/31/26.