Gonal-f RFF Redi-ject — Highmark
infertility
Preferred products
- Follistim AQ
Initial criteria
- Member is female
- Member is using the product for infertility
- If using as part of ART treatment program, member has associated ART/IVF medical benefit
- If member does not have the NSF formulary, member has experienced therapeutic failure or intolerance to plan-preferred Follistim AQ