Chorionic gonadotropin for injection — Medica
covered when patient’s benefit includes infertility coverage and policy’s Preferred Specialty Management criteria are met
Preferred products
- Novarel
- Ovidrel
Initial criteria
- Patient’s benefit includes infertility coverage OR benefit exclusion override criteria are met
- Patient has tried one Preferred Product (when clinically appropriate) prior to approval of Non‑Preferred Product
Approval duration
as noted in policy (duration not specified)