Sogroya — United Healthcare

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