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Novarel (chorionic gonadotropin) — Highmark

primary or secondary hypogonadotropic hypogonadism

Initial criteria

  • Member meets one of the following: (1) Female using the product for infertility AND if using as part of ART treatment program, has associated ART/IVF benefit OR (2) Male meeting one of the following: (a) Adult meeting specified criteria (not fully shown in extract) OR (b) Other male indication per policy continuation