Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerPolicy UpdatesReproductive Health & FertilityColorado Rocky Mountain Cetrotide Coverage | OpenP…
    Ask Trek AI about this page
    CurrentColorado Rocky Mountain Health PlansPolicy N/A

    Cetrotide (cetrorelix acetate) Step Therapy

    Customize your policy alerts

    Sign up for all Colorado Rocky Mountain Health Plans policy alerts

    Know when Colorado Rocky Mountain Health Plans releases new policies or updates existing guidance.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Coverage of Cetrotide for members undergoing ovarian stimulation requires failure, contraindication, or intolerance to ganirelix acetate manufactured by Organon Global, Inc.; infertility exclusions and plan-specific benefits may also affect coverage.

    Policy Summary
    PayerColorado Rocky Mountain Health Plans
    PolicyCetrotide (cetrorelix acetate) Step Therapy
    Policy CodePolicy N/A
    Change TypeAnnual reference updateno material coverage changes
    Effective DateNovember 1, 2026
    Last ReviewAug 1, 2026
    Next Review DateN/A
    Key ActionDocument failure, contraindication, or intolerance to Organon Global, Inc. ganirelix acetate before requesting Cetrotide coverage.
    SourceLink
    POLICY UPDATE CHANGES

    The annual review updated the policy references.

    1Required preferred-agent trial before Cetrotide
    2 monthsAuthorization duration
    GnRH antagonistTherapeutic class

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    InfertilityCoverage limitation

    Coverage Criteria

    Cetrotide will be approved when the following criterion is met:

    The member has a history of failure, contraindication, or intolerance to ganirelix acetate (Organon Global Inc. formulations).

    Authorization will be issued for 2 months.

    Infertility is typically excluded from coverage. Refer to the member-specific benefit plan documents to determine whether infertility services are excluded. State mandates may apply, and federal regulatory requirements, member-specific benefit plan coverage, and other policies or utilization management programs may also affect the coverage criteria.

    Provider Actions

    Prior Authorization

    Establish the ganirelix exception

    Requests for Cetrotide must establish a history of failure, contraindication, or intolerance to ganirelix acetate manufactured by Organon Global, Inc. Authorization is issued for 2 months.

    Step Therapy

    Try ganirelix before Cetrotide

    Members must use ganirelix acetate formulations from Organon Global, Inc. before Cetrotide can be covered, unless there is a history of failure, contraindication, or intolerance to that product.

    Denial Risk

    Document a qualifying ganirelix history

    Coverage may be denied when the member does not have a documented history of failure, contraindication, or intolerance to ganirelix acetate formulations from Organon Global, Inc.

    Background

    Cetrotide (cetrorelix acetate) and ganirelix acetate are synthetic decapeptides with gonadotropin-releasing hormone antagonist activity. Both agents are indicated to inhibit premature luteinizing hormone surges in women undergoing ovarian stimulation. Ganirelix acetate is used as the preferred lower-cost alternative before Cetrotide.

    Policy Summary
    PayerColorado Rocky Mountain Health Plans
    PolicyCetrotide (cetrorelix acetate) Step Therapy
    Policy CodePolicy N/A
    Change TypeAnnual reference updateno material coverage changes
    Effective DateNovember 1, 2026
    Last ReviewAug 1, 2026
    Next Review DateN/A
    Key ActionDocument failure, contraindication, or intolerance to Organon Global, Inc. ganirelix acetate before requesting Cetrotide coverage.
    SourceLink
    On This Page
    Coverage CriteriaProvider ActionsBackground