Zomacton — CareFirst (Caremark)
growth hormone deficiency in adults associated with hypothalamic-pituitary disease, congenital structural abnormalities, or childhood-onset GH deficiency
Preferred products
- Genotropin
- Humatrope
- Norditropin
- Nutropin AQ
- Omnitrope
- Saizen
Initial criteria
- Member meets ANY of the following criteria:
- Current IGF-1 level is not elevated for age and gender
- Member has organic hypothalamic-pituitary disease (e.g., suprasellar mass with previous surgery and cranial irradiation) with ≥ 3 documented pituitary hormone deficiencies
- Member has genetic or congenital structural hypothalamic-pituitary defects
- Member has childhood-onset GH deficiency and a congenital abnormality of the CNS, hypothalamus, or pituitary