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Lupron Depot (leuprolide acetate)Medica

Premenstrual Disorders

Initial criteria

  • Patient is ≥ 18 years of age; AND
  • According to the prescriber, the patient has severe, refractory premenstrual symptoms; AND
  • Patient has tried ONE of the following therapies (i or ii):
  • i. A selective serotonin reuptake inhibitor (SSRI); OR
  • ii. A combined oral contraceptive.

Approval duration

1 year