Histrelin Acetate (Vantas, Supprelin LA)
Defines medical necessity criteria, initial and continued therapy requirements, covered indications (prostate cancer palliative, central precocious puberty, and select off-label gender dysphoria/gender transition), dosing limits (one 50 mg implant per 12 months), provider documentation requirements, approval durations by line of business, and related billing HCPCS/J-codes.
Added Commercial line of business; added off-label use criteria for gender dysphoria or gender transition.
For prostate cancer, added requirement that request is for palliative treatment to align with FDA indication; corrected units for basal LH to mIU/mL.
For gender dysphoria and gender transition, added requirement for provider attestation of understanding State regulations and reference to Movement Advancement Project.
For gender dysphoria/gender transition continuation requests, added example of positive response: member continues to meet their individual goals of therapy for gender dysphoria.
For HIM, added state exclusions list where gender dysphoria and gender transition treatment is not covered (Marketplace Integrity and Affordability rule).
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.