somatropin — Medica
Chronic Kidney Disease in a Child or Adolescent
Initial criteria
- Patient has or had chronic kidney disease as defined by a glomerular filtration rate < 60 milliliters/minute
- Patient has persistent growth failure defined as BOTH of the following: baseline height < 5th percentile for age and gender AND baseline height velocity below 25th percentile over 3 months in infants (≤ 1 year) or 6 months in children/adolescents
- Medication prescribed by or in consultation with an endocrinologist or a nephrologist
Reauthorization criteria
- Patient is continuing somatropin therapy (established on somatropin for ≥ 10 months)
- Patient’s height has increased by ≥ 2 cm/year in the most recent year
- Patient’s epiphyses are open
Approval duration
1 year