Serostim (somatropin) — CareFirst (Caremark)
Treatment of HIV patients with wasting or cachexia to increase lean body mass and body weight, and improve physical endurance
Preferred products
- cyproheptadine
- Marinol (dronabinol)
- Megace (megestrol acetate)
- testosterone therapy
Initial criteria
- Member is currently receiving antiretroviral therapy
- Member has had a trial with suboptimal response or intolerance to alternative therapies (cyproheptadine, Marinol (dronabinol), Megace (megestrol acetate), or testosterone therapy if hypogonadal) OR has a contraindication to alternative therapies
- Member has a body mass index (BMI) < 18.5 kg/m2 prior to initiating therapy with Serostim
Reauthorization criteria
- Member is currently receiving antiretroviral therapy
- Member is currently receiving treatment with Serostim (excluding use obtained as samples or via manufacturer’s patient assistance programs)
- Member’s current BMI < 27 kg/m2
Approval duration
12 weeks