Prior authorization required

Does Humana require prior authorization for Trelstar?

Humana 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	715 / 817	715	Prior authorization required
triptorelin 3.75 MG Injection [Trelstar]905059	715 / 817	715	Prior authorization required
triptorelin 11.25 MG Injection [Trelstar]905064	715 / 817	715	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
Humana Cleveland Clinic Preferred (HMO-POS)	H6622-023	4	Yes	No	No
Humana Community (HMO-POS)	H4623-002	4	Yes	No	No
Humana Community (HMO)	H0292-001	4	Yes	No	No
Humana Community (HMO)	H1036-236	4	Yes	No	No
Humana Community (HMO)	H1036-332	4	Yes	No	No
Humana Community (HMO)	H5178-002	4	Yes	No	No
Humana Community (HMO)	H5619-159	4	Yes	No	No
Humana Community HMO Diabetes and Heart (HMO C-SNP)	H1036-234	4	Yes	No	No
Humana Community HMO Diabetes and Heart (HMO C-SNP)	H1468-017	4	Yes	No	No
Humana Community HMO SNP-DE (HMO D-SNP)	H1036-235	4	Yes	No	No
Humana Direct Choice Giveback (PPO)	H5216-406	4	Yes	No	No
Humana Direct Choice Giveback (PPO)	H5216-424	4	Yes	No	No
Humana Direct Choice Giveback (PPO)	H5216-431	4	Yes	No	No
Humana Direct Choice Giveback (PPO)	H5216-452	4	Yes	No	No
Humana Direct Choice Giveback (PPO)	H5970-031	4	Yes	No	No
Humana Direct Choice Giveback (PPO)	H7617-112	4	Yes	No	No
Humana Direct Choice GIveback (PPO)	H5970-032	4	Yes	No	No
Humana Dual Fully Integrated (HMO D-SNP)	H4329-001	4	Yes	No	No
Humana Dual Fully Integrated H2875-001 (HMO-POS D-SNP)	H2875-001	4	Yes	No	No
Humana Dual Fully Integrated H2875-003 (HMO D-SNP)	H2875-003	4	Yes	No	No
Humana Dual Integrated (HMO D-SNP)	H0963-001	4	Yes	No	No
Humana Dual Integrated (HMO D-SNP)	H1036-339	4	Yes	No	No
Humana Dual Integrated (HMO D-SNP)	H1036-340	4	Yes	No	No
Humana Dual Integrated (HMO D-SNP)	H1036-341	4	Yes	No	No
Humana Dual Integrated (HMO D-SNP)	H1396-001	4	Yes	No	No
Humana Dual Select H0028-078 (HMO D-SNP)	H0028-078	4	Yes	No	No
Humana Dual Select H0028-079 (HMO D-SNP)	H0028-079	4	Yes	No	No
Humana Dual Select H1036-307 (HMO D-SNP)	H1036-307	4	Yes	No	No
Humana Dual Select H1036-329 (HMO D-SNP)	H1036-329	4	Yes	No	No
Humana Dual Select H1951-056 (HMO D-SNP)	H1951-056	4	Yes	No	No
Humana Dual Select H2875-005 (HMO D-SNP)	H2875-005	4	Yes	No	No
Humana Dual Select H2875-006 (HMO-POS D-SNP)	H2875-006	4	Yes	No	No
Humana Dual Select H4939-002 (HMO-POS D-SNP)	H4939-002	4	Yes	No	No
Humana Dual Select H5216-206 (PPO D-SNP)	H5216-206	4	Yes	No	No
Humana Dual Select H5216-298 (PPO D-SNP)	H5216-298	4	Yes	No	No
Humana Dual Select H5216-361 (PPO D-SNP)	H5216-361	4	Yes	No	No
Humana Dual Select H5216-385 (PPO D-SNP)	H5216-385	4	Yes	No	No
Humana Dual Select H5525-046 (PPO D-SNP)	H5525-046	4	Yes	No	No
Humana Dual Select H5525-072 (PPO D-SNP)	H5525-072	4	Yes	No	No
Humana Dual Select H5619-075 (HMO D-SNP)	H5619-075	4	Yes	No	No
Humana Dual Select H5619-093 (HMO D-SNP)	H5619-093	4	Yes	No	No
Humana Dual Select H5619-126 (HMO-POS D-SNP)	H5619-126	4	Yes	No	No
Humana Dual Select H5619-165 (HMO D-SNP)	H5619-165	4	Yes	No	No
Humana Dual Select H6622-027 (HMO-POS D-SNP)	H6622-027	4	Yes	No	No
Humana Dual Select H7617-039 (PPO D-SNP)	H7617-039	4	Yes	No	No
Humana Dual Select H7617-074 (PPO D-SNP)	H7617-074	4	Yes	No	No
Humana Dual Select H7617-083 (PPO D-SNP)	H7617-083	4	Yes	No	No
Humana Essentials Plus Giveback H0028-063 (HMO)	H0028-063	4	Yes	No	No
Humana Essentials Plus Giveback H1036-271 (HMO)	H1036-271	4	Yes	No	No
Humana Essentials Plus Giveback H5216-308 (PPO)	H5216-308	4	Yes	No	No
Humana Essentials Plus Giveback H5216-358 (PPO)	H5216-358	4	Yes	No	No
Humana Essentials Plus Giveback H5216-405 (PPO)	H5216-405	4	Yes	No	No
Humana Essentials Plus Giveback H5216-429 (PPO)	H5216-429	4	Yes	No	No
Humana Essentials Plus Giveback H5216-430 (PPO)	H5216-430	4	Yes	No	No
Humana Essentials Plus Giveback H5216-435 (PPO)	H5216-435	4	Yes	No	No
Humana Essentials Plus Giveback H5216-435 (PPO)	H5216-435	4	Yes	No	No
Humana Essentials Plus Giveback H5216-435 (PPO)	H5216-435	4	Yes	No	No
Humana Essentials Plus Giveback H7617-017 (PPO)	H7617-017	4	Yes	No	No
Humana Essentials Plus Giveback H7617-024 (PPO)	H7617-024	4	Yes	No	No
Humana Essentials Plus Giveback H7617-035 (PPO)	H7617-035	4	Yes	No	No
Humana Essentials Plus Giveback H7617-100 (PPO)	H7617-100	4	Yes	No	No
Humana FMOL Baton Rouge H1951-053 (HMO)	H1951-053	4	Yes	No	No
Humana Full Access Giveback H5216-306 (PPO)	H5216-306	4	Yes	No	No
Humana Full Access Giveback H5216-311 (PPO)	H5216-311	4	Yes	No	No
Humana Full Access Giveback H5216-393 (PPO)	H5216-393	4	Yes	No	No
Humana Full Access Giveback H7617-058 (PPO)	H7617-058	4	Yes	No	No
Humana Full Access Giveback H7617-110 (PPO)	H7617-110	4	Yes	No	No
Humana Full Access Giveback H7617-111 (PPO)	H7617-111	4	Yes	No	No
Humana Full Access H5216-011 (PPO)	H5216-011	4	Yes	No	No
Humana Full Access H5216-124 (PPO)	H5216-124	4	Yes	No	No
Humana Full Access H5216-192 (PPO)	H5216-192	4	Yes	No	No
Humana Full Access H5216-287 (PPO)	H5216-287	4	Yes	No	No
Humana Full Access H5216-333 (PPO)	H5216-333	4	Yes	No	No
Humana Full Access H5216-384 (PPO)	H5216-384	4	Yes	No	No
Humana Full Access H5216-407 (PPO)	H5216-407	4	Yes	No	No
Humana Full Access H5216-410 (PPO)	H5216-410	4	Yes	No	No
Humana Full Access H5216-411 (PPO)	H5216-411	4	Yes	No	No
Humana Full Access H5216-412 (PPO)	H5216-412	4	Yes	No	No
Humana Full Access H5216-432 (PPO)	H5216-432	4	Yes	No	No
Humana Full Access H5525-034 (PPO)	H5525-034	4	Yes	No	No
Humana Full Access H5525-042 (PPO)	H5525-042	4	Yes	No	No
Humana Full Access H7617-008 (PPO)	H7617-008	4	Yes	No	No
Humana Full Access H7617-009 (PPO)	H7617-009	4	Yes	No	No
Humana Full Access H7617-020 (PPO)	H7617-020	4	Yes	No	No
Humana Full Access H7617-025 (PPO)	H7617-025	4	Yes	No	No
Humana Full Access H7617-026 (PPO)	H7617-026	4	Yes	No	No
Humana Full Access H7617-028 (PPO)	H7617-028	4	Yes	No	No
Humana Full Access H7617-029 (PPO)	H7617-029	4	Yes	No	No
Humana Full Access H7617-052 (PPO)	H7617-052	4	Yes	No	No
Humana Full Access H7617-053 (PPO)	H7617-053	4	Yes	No	No
Humana Full Access H7617-055 (PPO)	H7617-055	4	Yes	No	No
Humana Full Access H7617-069 (PPO)	H7617-069	4	Yes	No	No
Humana Full Access R0110-003 (Regional PPO)	R0110-003	4	Yes	No	No
Humana Full Access R0110-005 (Regional PPO)	R0110-005	4	Yes	No	No
Humana Full Access R0110-014 (Regional PPO)	R0110-014	4	Yes	No	No
Humana Full Access R0110-020 (Regional PPO)	R0110-020	4	Yes	No	No
Humana Fully Integrated H1036-280 (HMO D-SNP)	H1036-280	4	Yes	No	No
Humana Gold Choice H8145-004 (PFFS)	H8145-004	4	Yes	No	No
Humana Gold Choice H8145-006 (PFFS)	H8145-006	4	Yes	No	No
Humana Gold Choice H8145-032 (PFFS)	H8145-032	4	Yes	No	No

Showing 100 of 715 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.