Does Quartz Health Plan Corporation require prior authorization for Trelstar?
Prior authorization for Trelstar differs across Quartz Health Plan Corporation'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.
- This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| triptorelin 22.5 MG Injection [Trelstar]905057 | 10 / 10 | 10 | 0 | 10 | Prior authorization required |
| triptorelin 3.75 MG Injection [Trelstar]905059 | 0 / 10 | 0 | 0 | 0 | Not on formulary |
| triptorelin 11.25 MG Injection [Trelstar]905064 | 10 / 10 | 10 | 0 | 10 | 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 |
|---|---|---|---|---|---|
| Gundersen Quartz Med Advantage Basic D (w/Rx) (HMO) | H5262-032 | 4 | Yes | No | Yes |
| Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) | H5262-021 | 4 | Yes | No | Yes |
| Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) | H5262-029 | 4 | Yes | No | Yes |
| Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) | H5262-001 | 4 | Yes | No | Yes |
| Gundersen Quartz Med Advantage Value D (w/Rx) (HMO) | H5262-003 | 4 | Yes | No | Yes |
| UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) | H5262-033 | 4 | Yes | No | Yes |
| UW Health Quartz Med Advantage Core D (w/Rx) (HMO) | H5262-023 | 4 | Yes | No | Yes |
| UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) | H5262-030 | 4 | Yes | No | Yes |
| UW Health Quartz Med Advantage Elite D (w/Rx) (HMO) | H5262-007 | 4 | Yes | No | Yes |
| UW Health Quartz Med Advantage Value D (w/Rx) (HMO) | H5262-008 | 4 | Yes | No | Yes |
- 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.