Skytrofa — Medica
growth disorders as defined in the standard Growth Disorders – Skytrofa Prior Authorization Policy
Preferred products
- Ngenla
Initial criteria
- Patient meets the standard Growth Disorders – Skytrofa Prior Authorization Policy criteria
- AND patient meets ONE of the following (National Preferred Formulary and National Preferred Flex Formulary):
- • age < 3 years; OR
- • age ≥ 18 years; OR
- • has tried Ngenla for 6 months; OR
- • has experienced an intolerance with Ngenla
Approval duration
1 year