Letrozole Use for Treatment of Infertility

Aug 22, 2022

The Department is aware, through pharmacy dispensing data, that short-term claims for Letrozole have been prescribed for treatment of infertility. Letrozole is a preferred agent for the treatment of breast cancer.

Pursuant to Social Security Act, Section 1927 [42 U.S.C. 1396r–8] and MaineCare Benefits Manual Chapter II, Section 90, Physician Services, the off-label use of the preferred medication Letrozole, when it is used to promote fertility, is excluded from MaineCare coverage.

To ensure compliance with MaineCare policy, a Prior Authorization (PA) will be required for members with any claim that is greater than one tablet per day, and less than a 30-day supply, ensuring the medication is being used for a covered diagnosis. 

Members will be allowed to complete their current treatment, up to 6 cycles with a PA. No subsequent rounds of treatment will be covered.

For questions, please contact the Change Healthcare Provider Help Desk at 1-888-420-9711. MaineCare providers can also send inquiries via email.

Thank you for your continued support of MaineCare’s publicly funded pharmacy benefits programs.