Testosterone Undecanoate (Aveed) Injection

As defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce equivalent therapeutic or diagnostic results. Aveed (testosterone undecanoate) long-acting injectable anabolic-androgenic steroid is more costly to Aetna than other long-acting anabolic-androgenic steroids. There is a lack of reliable evidence that Aveed (testosterone undecanoate) is superior to the lower cost long-acting injectable anabolic-androgenic steroid Depo-Testosterone (testosterone cypionate) for medically necessary indications. Therefore, Aetna considers Aveed (testosterone undecanoate) to be medically necessary only for members who have a contraindication, intolerance or ineffective response to the available equivalent alternative long-acting injectable anabolic-androgenic steroids: Depo-Testosterone (testosterone cypionate).

This Clinical Policy Bulletin addresses testosterone undecanoate (Aveed) injection for commercial medical plans. For Medicare criteria, see Medicare Part B Criteria.

Precertification of testosterone undecanoate injection (Aveed) is required of all Aetna participating providers and members in applicable plan designs.  For precertification of testosterone undecanoate injection (Aveed), call (866) 752-7021 or fax (888) 267-3277. For Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification.

Note: Most policies specifically exclude coverage of steroids for performance enhancement.  For plans without this exclusion, androgens and anabolic steroids as well as other medical interventions for performance enhancement are not covered because performance enhancement of non-diseased individuals is not considered treatment of disease or injury.  Please check benefit plan descriptions for details.

Aetna considers age-related hypogonadism (also referred to as late-onset hypogonadism) as an exclusion for testosterone undecanoate therapy.

For gender dysphoria, the medication must be prescribed by or in consultation with a provider specialized in the care of transgender youth (e.g., pediatric endocrinologist, family or internal medicine physician, obstetrician-gynecologist) that has collaborated care with a mental health provider for members less than 18 years of age.