Sogroya — United Healthcare
Other diagnosis (not with aromatase inhibitors or androgens)
Initial criteria
- (a) Diagnosis of panhypopituitarism OR (b) Other diagnosis and not used in combination with: i. Aromatase inhibitors [e.g., Arimidex (anastrazole), Femara (letrazole)] ii. Androgens [e.g., Delatestryl (testosterone enanthate), Depo Testosterone (testosterone cypionate)]
- Prescribed by an endocrinologist
Reauthorization criteria
- Submission of medical records documenting an IGF-1 level within the past 12 months
- (a) Diagnosis of panhypopituitarism OR (b) Other diagnosis and not used in combination with: i. Aromatase inhibitors ii. Androgens
- Prescribed by an endocrinologist
Approval duration
12 months