Somatropin — United Healthcare
Noonan Syndrome
Initial criteria
- Diagnosis of Turner Syndrome confirmed by genetic testing OR Noonan Syndrome confirmed by clinical features consistent with Noonan Syndrome
- Growth charts show velocity deceleration; documentation of percentile/SD scores; calculated growth velocity
- Open epiphyses within last 12 months
- Tanner staging ≤ 4
- Prescribed by an endocrinologist
Reauthorization criteria
- Height increase ≥ 2 cm/year over previous year with documented measurements and growth chart
- Expected adult height not attained and goal documented
- Prescribed by an endocrinologist
Approval duration
12 months