​​Changes to medical policy on gonadotropin-releasing hormone agonist​

January 5, 2023

​Effective January 2, 2023, AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey, and AmeriHealth Administrators have updated their medical policy on gonadotropin-releasing hormone agonist (CamceviTM, Eligard®, Fensolvi®, Lupron Depot®).

Criteria and codes were updated in alignment with company-recognized drug compendia.  The coverage positions were added/revised for the following HCPCS codes:

  • J1950: Coverage changed from Not Medically Necessary to Medically Necessary for Breast Cancer and Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer.
  • J1951 (Fensolvi): Coverage changed from Medically Necessary to Not Medically Necessary for endometriosis, uterine fibroids, and gender dysphoria.
  • J1952 (Camcevi): Coverage was added for Not Medically Necessary indications in the policy.

For more information, view policy #08.01.33h: Gonadotropin-Releasing Hormone Agonist (CamceviTM, Eligard®, Fensolvi®, Lupron Depot®), which was published on December 30, 2022.