Increlex (mecasermin) — Medica

Initial criteria

• Patient is ≥ 2 years of age
• The epiphyses are open
• Height standard deviation score ≤ -3.0 at baseline
• Basal IGF-1 standard deviation score ≤ -3.0 at baseline
• Growth hormone concentration is normal or increased at baseline
• Patient will not be receiving concurrent treatment with growth hormone
• Medication is prescribed by or in consultation with a pediatric endocrinologist

Reauthorization criteria

• Patient’s height has increased by ≥ 2 cm/year in the most recent year
• The epiphyses are open
• Patient will not be receiving concurrent treatment with growth hormone

Approval duration

1 year