Prior authorization required

Does Cigna require prior authorization for Trelstar?

Cigna requires prior authorization for Trelstar on every Medicare Part D plan of theirs that covers it.

Every plan from this payer that covers the drug requires authorization before it is dispensed.

By product strength

RxNorm product	Plans covering	Require prior auth	Status
triptorelin 22.5 MG Injection [Trelstar]905057	171 / 171	171	Prior authorization required
triptorelin 3.75 MG Injection [Trelstar]905059	171 / 171	171	Prior authorization required
triptorelin 11.25 MG Injection [Trelstar]905064	171 / 171	171	Prior authorization required

Product names come from RxNorm (U.S. National Library of Medicine).

Plan-by-plan detail — triptorelin 22.5 MG Injection [Trelstar]

Trelstar has 3 products in the corpus; this table is for triptorelin 22.5 MG Injection [Trelstar], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
HealthSpring Achieve (HMO C-SNP)	H4407-034	4	Yes	No	No
HealthSpring Achieve (HMO C-SNP)	H4513-094	4	Yes	No	No
HealthSpring Achieve (HMO C-SNP)	H4513-097	4	Yes	No	No
HealthSpring Achieve (HMO C-SNP)	H4513-098	4	Yes	No	No
HealthSpring Alliance (HMO)	H4513-064	4	Yes	No	No
HealthSpring Preferred (HMO)	H0439-008	4	Yes	No	No
HealthSpring Preferred (HMO)	H0439-009	4	Yes	No	No
HealthSpring Preferred (HMO)	H0439-010	4	Yes	No	No
HealthSpring Preferred (HMO)	H0439-011	4	Yes	No	No
HealthSpring Preferred (HMO)	H0439-013	4	Yes	No	No
HealthSpring Preferred (HMO)	H0439-015	4	Yes	No	No
HealthSpring Preferred (HMO)	H0439-015	4	Yes	No	No
HealthSpring Preferred (HMO)	H0439-020	4	Yes	No	No
HealthSpring Preferred (HMO)	H0672-005	4	Yes	No	No
HealthSpring Preferred (HMO)	H0672-006	4	Yes	No	No
HealthSpring Preferred (HMO)	H0672-013	4	Yes	No	No
HealthSpring Preferred (HMO)	H0672-024	4	Yes	No	No
HealthSpring Preferred (HMO)	H4407-030	4	Yes	No	No
HealthSpring Preferred (HMO)	H4407-030	4	Yes	No	No
HealthSpring Preferred (HMO)	H4407-030	4	Yes	No	No
HealthSpring Preferred (HMO)	H4407-033	4	Yes	No	No
HealthSpring Preferred (HMO)	H4407-035	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-026	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-030	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-037	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-038	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-049	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-049	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-049	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-049	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-049	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-050	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-052	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-061	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-061	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-061	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-061	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-061	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-074	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-077	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-077	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-077	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-077	4	Yes	No	No
HealthSpring Preferred (HMO)	H4513-085	4	Yes	No	No
HealthSpring Preferred (HMO)	H5410-018	4	Yes	No	No
HealthSpring Preferred (HMO)	H5410-024	4	Yes	No	No
HealthSpring Preferred (HMO)	H5410-059	4	Yes	No	No
HealthSpring Preferred (HMO)	H5410-060	4	Yes	No	No
HealthSpring Preferred (HMO)	H7020-011	4	Yes	No	No
HealthSpring Preferred (HMO)	H7020-011	4	Yes	No	No
HealthSpring Preferred (HMO)	H7020-011	4	Yes	No	No
HealthSpring Preferred (HMO)	H9460-001	4	Yes	No	No
HealthSpring Preferred AL (HMO)	H4513-046	4	Yes	No	No
HealthSpring Preferred AL (HMO)	H4513-046	4	Yes	No	No
HealthSpring Preferred Full Savings (HMO)	H4513-088	4	Yes	No	No
HealthSpring Preferred Full Savings (HMO)	H4513-089	4	Yes	No	No
HealthSpring Preferred Full Savings (HMO)	H4513-090	4	Yes	No	No
HealthSpring Preferred Full Savings (HMO)	H4513-091	4	Yes	No	No
HealthSpring Preferred Full Savings (HMO)	H4513-092	4	Yes	No	No
HealthSpring Preferred Full Savings (HMO)	H4513-093	4	Yes	No	No
HealthSpring Preferred GA (HMO)	H0439-003	4	Yes	No	No
HealthSpring Preferred GA (HMO)	H0439-003	4	Yes	No	No
HealthSpring Preferred Plus (HMO)	H0439-006	4	Yes	No	No
HealthSpring Preferred Plus (HMO)	H4407-027	4	Yes	No	No
HealthSpring Preferred Plus (HMO)	H4513-087	4	Yes	No	No
HealthSpring Preferred Plus (HMO)	H4513-087	4	Yes	No	No
HealthSpring Preferred Plus (HMO)	H4513-087	4	Yes	No	No
HealthSpring Preferred Plus (HMO)	H4513-087	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H0439-016	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H0439-017	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H0439-018	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H0439-019	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H0439-021	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H0672-016	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H0672-017	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-068	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-068	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-068	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-073	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-083	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-083	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-083	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-083	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-083	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-083	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-083	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-086	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H4513-095	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H5410-026	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H7020-010	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H7020-010	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H7020-010	4	Yes	No	No
HealthSpring Preferred Savings (HMO)	H9460-003	4	Yes	No	No
HealthSpring Premier (HMO-POS)	H0439-024	4	Yes	No	No
HealthSpring Premier (HMO-POS)	H4513-036	4	Yes	No	No
HealthSpring Premier (HMO-POS)	H4513-084	4	Yes	No	No
HealthSpring Premier (HMO-POS)	H4513-096	4	Yes	No	No
HealthSpring Primary (HMO)	H4513-035	4	Yes	No	No
HealthSpring Primary (HMO)	H4513-053	4	Yes	No	No
HealthSpring TotalCare (HMO D-SNP)	H0439-002	4	Yes	No	No

Showing 100 of 171 covering plans.

Source

Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — Basic Drugs Formulary File

Effective: 2026-06-30
Retrieved: 2026-07-19
SHA-256: e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae

We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.

Trelstar at other payers

Or see Trelstar across every payer at once.

Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.