Testosterone products — Highmark

Initial criteria

• Diagnosis of gender dysphoria or gender identity disorder (ICD-10: F64)
• If member is age ≤15 years, drug prescribed by a clinician competent in the evaluation and induction of pubertal development

Reauthorization criteria

• Prescriber attests member has experienced positive clinical response to testosterone therapy
• Member requires continued therapy with a testosterone product

Approval duration

12 months