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  • Current: Aetna - Testosterone Undecanoate Injection (Aveed)

Prev Index Gender Dysphoria/Reassignment [10 of 162] Next

Aetna

Testosterone Undecanoate Injection (Aveed)


Policy: Testosterone Undecanoate Injection (Aveed)
Policy Number: 0528
Last Update: 2023-07-14
Next Update: 2024-04-25

Notes:

  1. Gender dysphoria
    1. For continued treatment for gender dysphoria in members requesting reauthorization for gender dysphoria when all of the following criteria are met:
      1. The member has a diagnosis of gender dysphoria; and
      2. The member is able to make an informed decision to engage in hormone therapy; and
      3. The member’s comorbid conditions are reasonably controlled; and
      4. The member has been educated on any contraindications and side effects to therapy; and
      5. Before the start of therapy, the member has been informed of fertility preservation options; or
    2. For continued treatment for gender dysphoria in adolescent members requesting reauthorization when all of the following criteria are met:
      1. The member has a diagnosis of gender dysphoria; and
      2. The member is able to make an informed decision to engage in hormone therapy; and
      3. The member has previously reached Tanner stage 2 of puberty or greater; and
      4. The member’s comorbid conditions are reasonably controlled; and
      5. The member has been educated on any contraindications and side effects to therapy; and
      6. Before the start of therapy, the member has been informed of fertility preservation options.

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Updated on Nov 27, 2023

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