CurrentColorado Rocky Mountain Health Plans | UnitedHealthcare Pharmacy Clinical Pharmacy ProgramsPolicy N/A

Crinone® (progesterone gel) - Step Therapy - UnitedHealthcare Commercial Plansopen_in_new

Step therapy prior-authorization policy for Crinone (progesterone gel) for UnitedHealthcare Commercial Plans, defining required prior treatments or continuation criteria for infertility, secondary amenorrhea, and other non-infertility indications; authorizations issued for 12 months. Effective 2026-04-01.

Policy Summary

PayerColorado Rocky Mountain Health Plans | UnitedHealthcare Pharmacy Clinical Pharmacy Programs

PolicyCrinone® (progesterone gel) - Step Therapy - UnitedHealthcare Commercial Plansopen_in_new

Policy CodePolicy N/A

Change TypeAuthorization duration revised; annual reference updates

Effective DateApr 1, 2026

Next Review Date

Key ActionCrinone requires prior authorization and will be approved only if step criteria are met (history of failure/contraindication/intolerance to specified comparators or continuation of current therapy).

SourceLink

POLICY UPDATE CHANGES

Authorization duration updated to 12 months (noted in 1/2025 change).

Annual reviews with reference updates through 1/2026; no clinical policy statement changes in some prior years.

12Authorization Duration

2Formulations Covered with Criteria

3Required Step Comparator Products

Coverage Summary

Coverage stance: covered_with_criteria for Crinone 4% and Crinone 8% with step therapy prior-authorization requirements. Effective date: 2026-04-01. Last review: 2026-01-01. Scope: Step therapy prior-authorization policy for Crinone (progesterone gel) for UnitedHealthcare Commercial Plans, defining required prior treatments or continuation criteria for infertility, secondary amenorrhea, and other non-infertility indications; authorizations issued for 12 months.

Infertility (ART) - Approval Criteria

Crinone 8% will be approved when ONE of the following is met:

ANY of the following

History of failure, contraindication or intolerance to Endometrin
Continuation of current ART (patient established on Crinone therapy for continuation of an ART regimen or maintaining an active pregnancy)

Secondary Amenorrhea - Approval Criteria

Crinone 4% or Crinone 8% will be approved when ALL of the following are met:

ALL of the following

ONE of
- progesterone oral capsules (generic Prometrium)
- medroxyprogesterone (generic Provera)

Other non-infertility indications (e.g., reduce risk of recurrent spontaneous preterm birth) - Approval Criteria

Crinone 4% or Crinone 8% will be approved when ONE of the following is met:

ANY of the following

History of failure, contraindication or intolerance to Endometrin
Continuation of current therapy

Authorization duration: 12 months. Policy applies to UnitedHealthcare Commercial Plans. Effective date: 2026-04-01. Last review: 2026-01-01.

Provider Actions & Authorization Requirements

Prior Authorization

Step therapy prior authorization required

Crinone requires prior authorization and will be approved only when the step criteria are met (history of failure/contraindication/intolerance to specified comparators or continuation of current therapy).

Documentation Required

Documentation of failure/contraindication/intolerance

Providers must document a history of failure, contraindication, or intolerance to the specified comparator product or document that the member is continuing current therapy.

Infertility (ART) and other non-infertility indications: Endometrin
Secondary amenorrhea: progesterone oral capsules (generic Prometrium) or medroxyprogesterone (generic Provera)

Billing Rule

Authorization duration

Authorizations for approved Crinone prescriptions will be issued for 12 months.

Prior Authorization

Automated approval pathways

UnitedHealthcare may approve initial and re-authorization based solely on previous claim/medication history, diagnosis codes (ICD-10) and/or claim logic; prior authorization notification may be in place.

Background

Background: Crinone (progesterone gel) is indicated for secondary amenorrhea and for progesterone supplementation as part of Assisted Reproductive Technology (ART). Endometrin (progesterone inserts) is an alternate indicated product to support embryo implantation and early pregnancy as part of ART. This program requires use of other progesterone products prior to approval of Crinone (step therapy); providers must document history of failure, contraindication, or intolerance to specified comparators, or document continuation of current therapy. Patients already established on Crinone for continuation of an ART regimen or maintaining an active pregnancy will be allowed to continue therapy.

Policy metadata (compact)

Effective date2026-04-01

Last review2026-01-01

Authorization duration12 months

Formulations covered with criteriaCrinone 8%, Crinone 4%

Scope summaryStep therapy prior-authorization policy for Crinone (progesterone gel) for UnitedHealthcare Commercial Plans, defining required prior treatments or continuation criteria for infertility, secondary amenorrhea, and other non-infertility indications; authorizations issued for 12 months. Effective 2026-04-01.

Revision History

1/2025material_change

Annual review updated authorization to 12 months and updated references.

2/2018P&T_approval

Program created (New program).

2/2019annual_review