CommercialPrior AuthMedium impact
Leuprolide Acetate Depot Suspension (Lupron Depot-Ped®)
BCBS Tennessee·TN · Pediatrics, Endocrinology, OB-GYN +1 more·Medical Policy
Effective date
Dec 1, 2026
We identified it
Sep 10, 2026
Summary
BlueCross BlueShield of Tennessee is establishing new medical policy for Leuprolide Acetate Depot Suspension (Lupron Depot-Ped®) effective December 1, 2026, covering two indications: FDA-approved use for central precocious puberty (CPP) in pediatric patients, and compendial use for gender dysphoria in adolescents seeking gender-affirming care. The policy requires specific prior authorization criteria, provider specialties, and documentation for both indications, with 12-month authorization periods for initial and continuation therapy.
Action Required
By November 1, 2026: Billing and prior authorization teams must implement new workflow for Lupron Depot-Ped® claims. For CPP cases, require providers to submit laboratory documentation (GnRH agonist test results or pubertal LH levels on third-generation assay) and bone age assessment before authorization. For gender dysphoria cases, verify prescriber specialty (pediatric endocrinologist, family medicine, internal medicine, or OB-GYN with mental health collaboration for members under 18) and confirm member meets clinical criteria (Tanner stage 2+, informed consent documented, fertility preservation counseling documented, comorbidities controlled). Update authorization system to grant 12-month approvals for initial requests and reauthorizations. Flag any requests for members under 18 with gender dysphoria diagnosis for state regulatory review per Tennessee law. Train front-desk and authorization staff on new documentation requirements. Failure to obtain proper prior authorization will result in claim denials.