Zomacton — Point32Health
Noonan Syndrome
Preferred products
- Omnitrope
Initial criteria
- Patient age < 18 years
- Documented diagnosis with short stature or growth failure due to one (1) of the listed conditions
- Prescribed by or in consultation with an endocrinologist or nephrologist
Reauthorization criteria
- Patient age < 18 years
- Documented diagnosis with short stature or growth failure due to one (1) of the listed conditions
- Prescribed by or in consultation with an endocrinologist or nephrologist
- 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
- If diagnosis is chronic renal failure, documentation patient has not received a kidney transplant
Approval duration
12 months