Aveed (testosterone undecanoate) — CareFirst (Caremark)
Gender dysphoria (adult)
Initial criteria
- Member has a diagnosis of gender dysphoria
- Member is able to make an informed decision to engage in hormone therapy
- Member’s comorbid conditions are reasonably controlled
- Member has been educated on any contraindications and side effects to therapy
- Member has been informed of fertility preservation options
Reauthorization criteria
- Member has a diagnosis of gender dysphoria
- Member is able to make an informed decision to engage in hormone therapy
- Member’s comorbid conditions are reasonably controlled
- Member has been educated on any contraindications and side effects to therapy
- Before the start of therapy, the member has been informed of fertility preservation options
Approval duration
12 months