UnitedHealthcare
Lupron Depot (3-Month) (leuprolide (3 month))
Drugs for Cancer : Drugs for Cancer
  • Step Therapy: Endometriosis:
    ST Single Generic

  • Endometriosis:
    Duration: 6 Month(s)
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    Surgical Ablation to Prevent Recurrence Required: Yes
    Reauthorization Requirement(s): 2 of Recurrence of symptoms;Used in combination with add-back therapy
    Documented Diagnosis: Yes

  • Prior Authorization: Endometriosis:
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

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