Lupron Depot-Ped — Medical Mutual
Gender-Dysphoric/Gender-Incongruent persons; persons undergoing gender reassignment (female-to-male or male-to-female)
Initial criteria
- Prescribed by or in consultation with an endocrinologist or a physician who specializes in the treatment of transgender patients
Reauthorization criteria
- Response to therapy is required for continuation of therapy
Approval duration
1 year