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State Health Plan: Androgen and Anabolic Steroid Prior Authorization Program

Starting November 1, 2010, androgens and anabolic steroids - including oral, topical and injectable products will require a coverage review for all claims. The products include:

Androgens, oral and topical Androgens, injectable Anabolic steroids
  • Testosterone gel (Androgel®, Testim®)
  • Testosterone cypionate injection (Depo-Testosterone®)
  • Oxymetholone tablets (Anadrol-50®)
  • Testosterone transdermal system (Androderm®)
  • Testosterone enanthate injection (Delatestryl®)
  • Oxandrolone tablets (Oxandrin®)
  • Testosterone buccal system (Striant®)
  • Testosterone propionate injection
  • Nandrolone decanoate
  • Testosterone propionate (FirstTM-Testosterone ointment, FirstTM-Testosterone Moisturizing Cream)
  • Testosterone pellets (Testopel®)
  • Methyltestosterone tablets (Methitest®)
  • Methyltestosterone capsules (Testred®, Android®)
  • Fluoxymesterone tablets (Androxy®)

The State Health Plan is implementing this program to ensure appropriate utilization and to avoid the potential for misuse or abuse.

Coverage criteria include:

  • Testosterone products - Coverage is provided for males for the treatment of hypogonadism in patients with pre-treatment serum testosterone levels of < 300 ng/dL (< 10.4 nmol/L), and for the treatment of delayed puberty. Also, coverage is provided for females for the palliative treatment of metastatic inoperable breast cancer
  • Anabolic steroids - Coverage is provided for the treatment of hereditary angioedema, to promote weight gain, and for the treatment of anemia/stimulation of erythropoiesis.

Providers may call Medco toll-free at 1-800-417-1764, from 8 a.m. to 9 p.m., Eastern Time, Monday through Friday, to request a review. Members will be responsible for the full cost of the prescription if the provider does not receive approval during the coverage review.

Please visit the Plan website at www.shpnc.org for further information.