Zomacton — Point32Health
Intrauterine Growth Retardation (IUGR)
Preferred products
- Omnitrope
Initial criteria
- Patient age < 18 years
- Documented diagnosis of IUGR or SGA
- Birth weight or length >2 standard deviations below mean (or below 3rd percentile) for gestational age
- Patient has failed to catch up by age 2 years
- Prescribed by or in consultation with an endocrinologist
Reauthorization criteria
- Patient age < 18 years
- Documented diagnosis of IUGR or SGA
- 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