Zomacton — Point32Health
Idiopathic Growth Hormone Deficiency
Preferred products
- Omnitrope
Initial criteria
- Patient age < 18 years
- Documented diagnosis of one (1) of the listed conditions
- Documentation of one (1) of the following: pituitary gland removed OR failed response to one (1) standard growth hormone stimulation test (peak GH < 10 ng/mL)
- Prescribed by or in consultation with an endocrinologist
Reauthorization criteria
- Patient age < 18 years
- Documented diagnosis of one (1) of the listed conditions
- Prescribed by or in consultation with an endocrinologist
- Documentation patient’s epiphyses are open confirmed by radiograph of the wrist and hand
- Documentation of therapeutic response defined as growth velocity ≥ 2 cm compared with previous year
Approval duration
12 months