cetrorelix acetate — CareFirst (Caremark)
inhibition of premature luteinizing hormone (LH) surges in women undergoing ovulation induction or assisted reproductive technology (ART)
Initial criteria
- Member is undergoing ovulation induction or assisted reproductive technology (ART)
Reauthorization criteria
- All members (including new members) requesting authorization for continuation of therapy must meet all requirements in the coverage criteria section
Approval duration
12 months