Limited coverage criteria – leuprolide

Last updated on March 19, 2025

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Generic name	leuprolide

Special Authority criteria	Approval period
Diagnosis of precocious puberty	First approval: One year Renewals: One year
Diagnosis of endometriosis	First approval: Six months Renewal: Six months
Diagnosis indicating need to reduce sexual drive	Indefinite

Special Authority criteria

Approval period

Diagnosis of precocious puberty

First approval: One year

Renewals: One year

Diagnosis of endometriosis

First approval: Six months

Renewal: Six months

Diagnosis indicating need to reduce sexual drive

Indefinite

Practitioner exemptions

Pediatric endocrinologists

Special notes

For (1) & (2) criteria applicable for all plans, excluding Plan G
For (3) criteria applicable for all plans, including Plan G
For any cancer-related condition, please contact the British Columbia Cancer Agency at (604) 877-6098 ext. 4610

Special Authority request form(s)

Log in to eForms
HLTH 5328 – General Special Authority request (PDF, 656KB)

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