Zomacton — CareFirst (Caremark)

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