Estrogen Products and Progesterone Product (Gender Dysphoria)
Indications for Prior Authorization
Criteria
Estrogen and Progesterone Products
Please note this criteria only applies to the Federal Employee Health Benefit (FEHB) plan.
Non Formulary
Length of Approval: N/A - Requests for non-approvable diagnoses should not be approved
For diagnosis of Gender Dysphoria/Gender Incongruence (off-label)
- Requests for coverage for diagnoses of gender transition or gender dysphoria are not authorized and will not be approved
P & T Revisions
2025-12-05
References
Revision History
- 2025-12-05: Create Gender Dysphoria Exclusion Criteria
HEALTHY LIVING