Novarel — United Healthcare
Hypogonadotropic hypogonadism secondary to pituitary deficiency
Initial criteria
- Diagnosis of hypogonadism secondary to pituitary deficiency
- Low testosterone (below normal reference level provided by the physician’s laboratory)
- Low LH (below normal reference level provided by the physician’s laboratory) OR Low FSH (below normal reference level provided by the physician’s laboratory)
Reauthorization criteria
- Documentation of positive clinical response to therapy
Approval duration
12 months