Testosterone pellets (Testopel)

Testosterone pellets (Testopel)

OFFICE ADMINISTRATION

Indications for Prior Authorization:

• Primary hypogonadism
  • Testicular failure due to bilateral torsion, orchitis, vanishing testes syndrome, cryptorchidism, or orchidectomy
• Hypogonadotrophic hypogonadism
• LHRH deficiency, pituitary hypothalamic injury from tumors, trauma, or radiation
• Male delayed puberty

The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:

• Treatment of female patients with symptoms of menopause or decreased libido
• Palliation therapy in post-menopausal women with breast cancer
• Any other diagnosis not listed in the approved indications
• The drug is not approvable for use in men with breast or prostate cancer

All of the following must be met:

• Treatment failure with topical and intramuscular testosterone administration
• Failure is defined as the inability to achieve normal plasma testosterone levels

Dosing:

• Pellet SC implantation 150 mg to 450 mg every 3-6 months

Approval: 

2 months