Primary navigation

    Novarel

    J Code - J 0725
    Therapeutic area - Fertility, prevent spontaneous recurrent miscarriage

    Drug - Novarel (gonadotropin,chorionic,human)
    Therapeutic area - Fertility, Male hypogonadism

    Drug - Synarel (nafarelin acetate) (Synthetic gonadotropin releasing hormone)
    Therapeutic area - Fertility, endometriosis, central precocious puberty

    August 2008

    Criteria J 0725

    Human Chorionic Gonadotropin (hCG) (1,000 IU)

    • May not be used for fertility, for ovulation, or to help conception occur
    • May be authorized for payment for prevention of spontaneous, recurrent, miscarriage

    Criteria Novarel

    Alternative names: Chorex, Pregnyl, Profasi

    • Novarel is not to be covered for fertility, for ovulation or to help conception occur
    • Novarel may be used for cryptorchidism and hypogonadism in male children

    Criteria Synarel

    • Synarel is not to be covered for fertility
    • May be approved for endometriosis and central precocious puberty

    Questions?

    MHCP Provider Call Center 651-431-2700 or 800-366-5411

    back to top