UnitedHealthcare
Lupaneta Pack (leuprolide (3month)-norethind)
Hormones : Drugs for Women
  • Prior Authorization: Endometriosis:
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • 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): Recurrence of symptoms
    Documented Diagnosis: Yes

  • Step Therapy: Endometriosis:
    ST Single Generic

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