- Menotropins:
- Menopur- indicated for the development of multiple follicles and pregnancy in the ovulatory patients participating in the assisted reproductive technology (ART) program.
- Repronex- 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.
- Follitropin alpha (recombinant): Ovulation induction: Women: For the induction of ovulation and pregnancy in anovulatory infertile patients in whom the cause of infertility is functional and not caused by ovarian failure. Follicle stimulation: To stimulate the development of multiple follicles in ovulatory patients undergoing Assisted Reproductive Therapy (ART), e.g., in vitro fertilization.
- Follitropin beta (recombinant): Ovulation induction: For the induction of ovulation and pregnancy in anovulatory infertile patients in whom the cause of infertility is functional and not caused by ovarian failure. Follicle stimulation: To stimulate the development of multiple follicles in ovulatory patients undergoing Assisted Reproductive Therapy (ART), e.g., in vitro fertilization. Men: for the induction of spermatogenesis in men with primary and secondary hypogonadotropic hypogonadism in whom the cause of infertility is not due to primary testicular failure.
- Urofollitropin: Ovulation induction: For ovulation induction in patients who have previously received pituitary suppression. Multifollicular development during ART: for multiple follicular development (controlled ovarian stimulation) during ART cycles in patients who have previously received pituitarysuppression.
- Ganirelix: for the inhibition of premature luteinizing hormone (LH) surges in women undergoing controlled ovarian hyperstimulation.
- Cetrorelix: for the inhibition of premature luteinizing hormone (LH) surges in women undergoing controlled ovarian stimulation.
- Choriogonadotropin alfa: indicated for the 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. Ovulation Induction: For the induction of ovulation and pregnancy in anovulatory infertile patients in whom the cause of infertility is functional and not caused by ovarian failure.
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.