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XyostedMedica

Hypogonadism (primary or secondary) in males

Initial criteria

  • Approve for 1 year if ONE of the following:
  • A) Initial therapy – ALL of the following (i, ii, iii):
  • i. Patient has persistent signs and symptoms of androgen deficiency (pre-treatment) AND
  • ii. Two pre-treatment serum testosterone (total or bioavailable) measurements taken in the morning on two separate days AND
  • iii. Both values are low per normal laboratory reference values;
  • OR
  • B) Patient currently receiving testosterone therapy – BOTH of the following:
  • i. Patient has persistent signs and symptoms of androgen deficiency (pre-treatment) AND
  • ii. At least one pre-treatment serum testosterone (total or bioavailable) level was low per normal laboratory reference values.

Approval duration

1 year