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Nutropin — Highmark

Turner’s Syndrome

Initial criteria

  • Diagnosis of Turner’s Syndrome defined as 45, XO genotype (ICD-10: Q96)
  • For members above the age of 14 years, bone age ≤ 14 years
  • If request is for a non-preferred growth hormone product, member has experienced therapeutic failure or intolerance to all plan-preferred products

Reauthorization criteria

  • Clinical documentation indicating a growth velocity of at least 2 cm/year
  • Chronological age > 14 years and bone age ≤ 14 years OR chronological age ≤ 14 years

Approval duration

12 months