Does Elevance Health (Anthem) require prior authorization for Trelstar?
Elevance Health (Anthem) 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| triptorelin 22.5 MG Injection [Trelstar]905057 | 52 / 67 | 52 | 0 | 0 | Prior authorization required |
| triptorelin 3.75 MG Injection [Trelstar]905059 | 52 / 67 | 52 | 0 | 0 | Prior authorization required |
| triptorelin 11.25 MG Injection [Trelstar]905064 | 52 / 67 | 52 | 0 | 0 | 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 |
|---|---|---|---|---|---|
| Anthem Chronic Care (HMO-POS C-SNP) | H3447-037 | 4 | Yes | No | No |
| Anthem Chronic Care (HMO-POS C-SNP) | H3447-056 | 4 | Yes | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H0629-002 | 4 | Yes | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H4694-002 | 4 | Yes | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H5854-020 | 4 | Yes | No | No |
| Anthem Dual Advantage (PPO D-SNP) | H2441-001 | 4 | Yes | No | No |
| Anthem Dual Advantage (PPO D-SNP) | H2836-007 | 4 | Yes | No | No |
| Anthem Extra Help (HMO-POS) | H3447-024 | 4 | Yes | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H0629-001 | 4 | Yes | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H3447-018 | 4 | Yes | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H4694-004 | 4 | Yes | No | No |
| Anthem Full Dual Advantage (PPO D-SNP) | H2836-006 | 4 | Yes | No | No |
| Anthem Full Dual Advantage 2 (HMO D-SNP) | H3447-053 | 4 | Yes | No | No |
| Anthem Full Dual Advantage 2 (HMO D-SNP) | H4694-001 | 4 | Yes | No | No |
| Anthem Full Dual Advantage Select (HMO D-SNP) | H5854-013 | 4 | Yes | No | No |
| Anthem Full Dual Advantage Support (HMO D-SNP) | H4694-003 | 4 | Yes | No | No |
| Anthem HealthPlus Full Dual Advantage (HMO D-SNP) | H8432-042 | 4 | Yes | No | No |
| Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) | H8432-041 | 4 | Yes | No | No |
| Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) | H6988-004 | 4 | Yes | No | No |
| Anthem I PathWays Dual Care Advantage (HMO D-SNP) | H0629-003 | 4 | Yes | No | No |
| Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) | H0629-004 | 4 | Yes | No | No |
| Anthem Kidney Care (HMO-POS C-SNP) | H3447-033 | 4 | Yes | No | No |
| Anthem Kidney Care (HMO-POS C-SNP) | H5854-012 | 4 | Yes | No | No |
| Anthem Kidney Care (PPO C-SNP) | H8552-028 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-013 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-038 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-038 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H5854-019 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H5854-019 | 4 | Yes | No | No |
| Anthem Medicare Advantage (PPO) | H4036-026 | 4 | Yes | No | No |
| Anthem Medicare Advantage (PPO) | H4036-036 | 4 | Yes | No | No |
| Anthem Medicare Advantage (PPO) | H4909-014 | 4 | Yes | No | No |
| Anthem Medicare Advantage (Regional PPO) | R5941-014 | 4 | Yes | No | No |
| Anthem Medicare Advantage (Regional PPO) | R5941-016 | 4 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H3447-025 | 4 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H7220-004 | 4 | Yes | No | No |
| Anthem Medicare Advantage 2 (PPO) | H1607-015 | 4 | Yes | No | No |
| Anthem Medicare Advantage 2 (PPO) | H4036-030 | 4 | Yes | No | No |
| Anthem Medicare Advantage 2 (PPO) | H4909-026 | 4 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO) | H7220-009 | 4 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO) | H7220-009 | 4 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H1607-012 | 4 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-008 | 4 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-025 | 4 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-034 | 4 | Yes | No | No |
| Anthem Medicare Advantage 4 (HMO-POS) | H3447-039 | 4 | Yes | No | No |
| Anthem Medicare Advantage 4 (HMO) | H7220-010 | 4 | Yes | No | No |
| Anthem Medicare Advantage 4 (PPO) | H4036-017 | 4 | Yes | No | No |
- 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
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.