somatropin — Medica

Initial criteria

• Diagnosis confirmed by a heterozygous pathogenic variant in BRAF, KRAS, MAP2K1, MRAS, NRAS, PTPN11, RAF1, RASA2, RIT1, RRAS2, SOS1 or SOS2, or by either a heterozygous variant or biallelic pathogenic variants in LZTR1 OR prescriber made a clinical diagnosis of Noonan syndrome
• Baseline height < 5th percentile using a growth chart for children without Noonan syndrome
• Medication prescribed by or in consultation with an endocrinologist

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