Does Provider Partners Health Plan Of Pennsylvania, INC require prior authorization for Trelstar?
Prior authorization for Trelstar differs across Provider Partners Health Plan Of Pennsylvania, INC's Medicare Part D plans and product strengths — 2 of 3 Trelstar products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.
Some plans require authorization and others do not. The member's specific plan decides.
By product strength
| RxNorm product | Plans covering | Require prior auth | Status |
|---|---|---|---|
| triptorelin 22.5 MG Injection [Trelstar]905057 | 3 / 3 | 3 | Prior authorization required |
| triptorelin 3.75 MG Injection [Trelstar]905059 | 0 / 3 | 0 | Not on formulary |
| triptorelin 11.25 MG Injection [Trelstar]905064 | 3 / 3 | 3 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
- 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.