Somatropin — United Healthcare
Short-stature homeobox (SHOX) gene deficiency
Initial criteria
- Diagnosis of SHOX gene deficiency confirmed by genetic testing
- Growth charts show velocity deceleration; percentile/SD scores; calculated growth velocity
- Open epiphyses within last 12 months
- Tanner stage ≤ 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