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Covered Uses: | All FDA-approved indications not otherwise excluded from Part D. Plus, secondary amenorrhea, support of an established pregnancy. |
Exclusion Criteria: | Use in patients to supplement or replace progesterone in the management of infertility. |
Required Medical Information: | N/A |
Age Restrictions: | N/A |
Prescriber Restrictions: | N/A |
Coverage Duration: | Secondary amenorrhea, 12 months.Support of an established pregnancy, 9 months |
Other Criteria: | N/A |