Xyosted — CareFirst (Caremark)
Hypogonadotropic hypogonadism (congenital or acquired)
Preferred products
- testosterone enanthate injection
- Depo-Testosterone
- testosterone cypionate injection
Initial criteria
- Patient is an adult male
- Diagnosis of primary hypogonadism (congenital or acquired) or hypogonadotropic hypogonadism (congenital or acquired)
- Requested drug is NOT being prescribed for age-related (late-onset) hypogonadism