- Menopur (menotropins):
- Development of multiple follicles and pregnancy in ovulatory women as part of an Assisted Reproductive Technology (ART) cycle.
- Repronex (menotropins):
- In conjunction with human chorionic gonadotropin (hCG), is indicated for multiple follicular development (controlled ovarian stimulation) and ovulation induction in patients who have previously received pituitary suppression.
- Gonal-F RFF (follitropin alpha, recombinant):
- Induction of ovulation and pregnancy in oligo-anovulatory women in whom the cause of infertility is functional and not due toprimary ovarian failure.
- Development of multiple follicles in ovulatory women as part of an Assisted Reproductive Technology (ART) cycle.
- Follistim AQ (follitropin beta, recombinant):
- In women for: Induction of ovulation and pregnancy in anovulatory infertile women in whom the cause of infertility is functional and not due to primary ovarian failure.
- In women for: Pregnancy in normal ovulatory women undergoing controlled ovarian stimulation as part of an In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) cycle.
- In men for: Induction of spermatogenesis in men with primary and secondary hypogonadotropic hypogonadism (HH) in whom the cause of infertility is not due to primary testicular failure.
- Bravelle (urofollitropin):
- Induction of ovulation in women who have previously received pituitary suppression.
- Development of multiple follicles as part of an Assisted Reproductive Technology (ART) cycle in ovulatory women who have previously received pituitary suppression.
- Ganirelix:
- Inhibition of premature luteinizing hormone (LH) surges in women undergoing controlled ovarian hyperstimulation.
- Cetrotide (cetrorelix):
- For the inhibition of premature luteinizing hormone (LH) surges in women undergoing controlled ovarian stimulation.
- Ovidrel (choriogonadotropin alfa, recombinant):
- Induction of final follicular maturation and early luteinization in infertile women who have undergone pituitary desensitization and who have been appropriately pretreated with follicle-stimulating hormones (FSH) as part of an Assisted Reproductive Technology (ART) program such as in vitro fertilization and embryo transfer.
- Induction of ovulation and pregnancy in anovulatory infertile patients in whom the cause of infertility is functional and not due to primary ovarian failure.
- Novarel, Pregnyl (human chorionic gonadotropin [HCG]):
- Prepubertal cryptorchidism not due to anatomic obstruction.
- Selected cases of hypogonadotropic hypogonadism (hypogonadism secondary to a pituitary deficiency) in males
- Induction of ovulation and pregnancy in the anovulatory, infertile woman in whom the cause of anovulation is secondary and not due to primary ovarian failure, and who has been appropriately pretreated with human menotropins.
Coverage of drugs is first determined by the member’s pharmacy or medical benefit. Please consult with or refer to the Evidence of Coverage document.