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Nutropin AQ — Cigna

Growth Disorders – Growth Hormone

Preferred products

  • Genotropin
  • Omnitrope

Initial criteria

  • Patient meets the standard Growth Disorders – Growth Hormone Prior Authorization Policy criteria; AND
  • Patient has tried BOTH of the following products: Genotropin or Omnitrope [documentation required]; AND
  • Patient cannot continue to use BOTH Genotropin and Omnitrope due to a formulation difference in the inactive ingredient(s) which, according to the prescriber, would result in a significant allergy or serious adverse reaction [documentation required]