somatropin — Medica

Initial criteria

• Diagnosis established by identification of abnormal DNA methylation of chromosome 15q11.2-q13
• Medication prescribed by or in consultation with an endocrinologist (child or adult)

Reauthorization criteria

• Patient is continuing somatropin therapy (established on somatropin for ≥ 10 months)
• Child or adolescent: height has increased by ≥ 2 cm/year in the most recent year AND epiphyses are open
• Adult or adolescent with closed epiphyses and/or height velocity < 2 cm/year: physician must certify somatropin not used for anti-aging or athletic performance AND prescribed by or in consultation with an endocrinologist

Approval duration

1 year