Pa Med Nec Testosterone
Defines prior authorization and medical necessity criteria for testosterone products (topical gels/solutions/patches/oral/certain injectables like Xyosted) for treatment of hypogonadism and for gender dysphoria (female-to-male), including initial authorization, Xyosted-specific rules, and reauthorization requirements. Applies to covered members under the plan's pharmacy benefit; some products may be excluded.
Added requirement male at birth to orchiectomy, panhypopituitarism and genetic disorders requirement section (11/2025).
Added Undecatrex to program (2/2025).
Kyzatrex added to program (1/2023).
Increased initial authorization to 12 months and changed reauthorization to require a lab value within the past 12 months (1/2023).
Updated required testosterone level to less than 300 ng/dL based on 2018 guidelines (2/2019).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.