Leuprolide Acetate (Fensolvi®)

Before December 1, 2026: Billing and Prior Authorization teams must implement the following changes: (1) Create 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; (2) For 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; (3) Configure 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; (4) Set authorization duration to 12 months for both initial and continuation therapy; (5) For CPP continuation, verify member age restrictions (females <12 years, males <13 years) and absence of treatment failure; (6) Update encounter forms and provider communication to flag these requirements; (7) Train billing staff on age-restricted gender dysphoria criteria per Tennessee state regulatory guidelines. Claims processed without proper PA and documentation will be denied.