Summary
BlueCross BlueShield of Tennessee is establishing a new medical policy for Leuprolide Acetate (Fensolvi®) covering two indications: central precocious puberty (CPP) in pediatric patients and gender dysphoria in adolescents/young adults seeking gender-affirming care. The policy requires prior authorization for both indications with specific clinical documentation, provider qualifications, and continuation criteria. This policy takes effect December 1, 2026 and is currently marked 'Do Not Implement' until that date.
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What to do
Action · 9 steps
01Before December 1, 2026: Billing and Prior Authorization teams must implement the following changes.
02Create prior authorization (PA) workflows in billing system for Leuprolide Acetate (Fensolvi®) requiring documentation of either GnRH agonist test results or third-generation LH assay levels for CPP cases, plus bone age assessment and pathologic cause assessment.
03For gender dysphoria cases, establish PA requirements verifying diagnosis, informed consent capability, Tanner stage 2+ status, controlled comorbidities, counseling on contraindications/side effects, and fertility preservation discussion.
04Configure system to require specialty verification: CPP cases can be prescribed by any provider; gender dysphoria cases must be prescribed by or in consultation with pediatric endocrinologist, family/internal medicine, or OB-GYN with mental health collaboration for patients under 18.
05Set authorization duration to 12 months for both initial and continuation therapy.
06For CPP continuation, verify member age restrictions (females <12 years, males <13 years) and absence of treatment failure.
07Update encounter forms and provider communication to flag these requirements.
08Train billing staff on age-restricted gender dysphoria criteria per Tennessee state regulatory guidelines.
09Claims processed without proper PA and documentation will be denied.
Original notice
Leuprolide Acetate (Fensolvi®)
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