Summary
BlueCross BlueShield of Tennessee's medical policy for triptorelin (Triptodur) takes effect December 1, 2026. It covers the drug for central precocious puberty in patients 2 years of age and older, and for compendial uses including gender dysphoria, preservation of ovarian function, and prevention of recurrent menstrual-related attacks in acute porphyria, when all approval criteria are met. All other indications are considered experimental or investigational and not medically necessary.
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What to do
Action · 4 steps
01Before December 1, 2026: For initial central precocious puberty requests, submit laboratory report or medical record documentation of a pubertal response to a GnRH agonist test, or a pubertal basal level of luteinizing hormone on a third-generation LH assay, to initiate the prior authorization review.
02For gender dysphoria requests, the medication must be prescribed by or in consultation with a provider specialized in the care of transgender youth, and for members under 18 that provider must have collaborated care with a mental health provider.
03For acute porphyria requests, the medication must be prescribed by or in consultation with a provider experienced in the management of porphyrias.
04Central precocious puberty authorizations of 12 months may be granted when the diagnosis and age criteria are met, and continuation requires the member to be a female under 12 or a male under 13 who is not experiencing treatment failure.
Original notice
Triptorelin (Triptodur®)
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