Triptorelin Pamoate (Trelstar®)

By November 1, 2026: Billing and prior authorization teams must implement this new policy in the billing system. (1) Create prior authorization workflows requiring 12-month initial authorizations for prostate cancer, breast cancer ovarian suppression, salivary gland tumors, and uterine sarcoma; 3-month authorization for ovarian function preservation; and 12-month authorizations for gender dysphoria indications. (2) Update authorization request forms to require submission of Androgen Receptor (AR) positive status and Hormone Receptor (HR) positive status documentation where applicable. (3) For gender dysphoria cases: establish verification that prescribers are specialized providers (pediatric endocrinologist, family/internal medicine physician, or OB-GYN) with mental health provider collaboration for members under 18 years old, and verify compliance with Tennessee state regulatory guidelines for age restrictions. (4) Configure system rules for continuation of therapy reauthorizations based on clinical benefit criteria (e.g., serum testosterone <50 ng/dL for prostate cancer). (5) Train billing staff on all approval criteria for each indication. (6) Update internal communication to providers and front desk staff about the new policy. Failure to obtain prior authorization will result in claim denials.