Androgel 1.62% — CareFirst (Caremark)
Delayed puberty
Initial criteria
- Requested drug is NOT being prescribed for age-related hypogonadism (also referred to as late-onset hypogonadism)
- Request is for intramuscular testosterone enanthate injection (generic Delatestryl) OR testosterone propionate implant pellet (Testopel)
Reauthorization criteria
- All continuation of therapy requests must meet all requirements in the coverage criteria section
Approval duration
36 months