Nutropin AQ — CareFirst (Caremark)
Turner syndrome
Initial criteria
- Diagnosis confirmed by karyotyping; Pretreatment height < 5th percentile for age; Epiphyses are open
Reauthorization criteria
- Member currently receiving growth hormone product indicated for Turner syndrome; Epiphyses open; Growth rate > 2 cm/year unless clinical reason for lack of efficacy
Approval duration
12 months