State and School Employees' Health Insurance Plan - Leuprolide

By August 1, 2026: Billing team must immediately update billing system to deny or route for manual review claims using HCPCS codes J1952 and J1954, as these are now designated Not Medically Necessary. Update claim submission rules to flag Camcevi (leuprolide), Lutrate Depot, Vabrinty, and Fensolvi as non-covered formulations—these should be rejected at claim entry with appropriate denial messaging. Conversely, ensure Eligard and leuprolide acetate depot claims for advanced prostate cancer are processed as covered without prior authorization delays. Notify providers in oncology and urology that prior authorization requirements have changed for leuprolide formulations under this State and School Employees' plan. Update encounter forms and billing software rules to reflect the new coverage matrix. Failure to implement these changes will result in incorrect claim denials or improper approvals, impacting both patient care and revenue cycle.