Crinone 8% — Highmark
infertility (as part of an ART treatment program)
Preferred products
- Endometrin
Initial criteria
- The member is female AND one (1) of the following is met:
- 1. ALL of the following:
- a. The member is using the product for infertility.
- b. The member is using Crinone 8% as part of an ART treatment program.
- c. The member has the associated ART/IVF benefit.
- d. If the member does not have the NSF formulary, the member has experienced therapeutic failure or intolerance to Endometrin.
- OR
- 2. The member has a diagnosis of secondary amenorrhea.
Approval duration
6 months for infertility (including hypogonadotropic hypogonadism); 1 month for secondary amenorrhea