Leuprolide acetate (Eligard®, Vabrinty™)

By November 1, 2026: Billing and prior authorization teams must update internal systems and workflows to implement this new policy. (1) Create prior authorization requirements in the billing system for Leuprolide acetate claims with automatic routing based on indication code (prostate cancer, salivary gland tumor, breast cancer ovarian suppression, or gender dysphoria). (2) Update prior auth templates to require documentation of AR-positive and/or HR-positive status before claim submission. (3) For gender dysphoria indications, implement system checks to verify prescriber specialty qualifications (pediatric endocrinologist, family/internal medicine, or OB-GYN with mental health collaboration for members under 18). (4) Configure system to grant 12-month authorization periods with automatic reauthorization workflows based on continuation criteria specific to each indication (e.g., testosterone <50 ng/dL for prostate cancer, no disease progression for salivary gland tumors, continued endocrine therapy for breast cancer up to 5 years). (5) Train providers and front desk staff that all Leuprolide acetate prescriptions require prior authorization before dispensing. (6) Update encounter forms and clinical documentation templates to capture required clinical information. Failure to obtain prior authorization will result in claim denials.