Saizen — CareFirst (Caremark)
Chronic kidney disease (CKD)
Initial criteria
- For members < 2.5 years of age: pretreatment height > 2 SD below mean and slow growth velocity; for members ≥ 2.5 years: pretreatment height > 2 SD below mean and 1-year height velocity > 1 SD below mean OR pretreatment 1-year height velocity > 2 SD below mean; epiphyses open.
Reauthorization criteria
- Member currently receiving GH therapy; epiphyses open; growth rate > 2 cm/year unless clinical reason for lack of efficacy.
Approval duration
12 months