Prior Authorization

Growth Hormone

For members over 18, growth hormone is indicated for those:

Who have a history of pituitary or hypothalamic disease secondary to tumor, surgery, inflammation, radiation therapy, severe head trauma or structural abnormality and panhypopituitarism.
Who have had childhood onset of growth hormone deficiency demonstrated by testing during childhood.
Who had a demonstrated biochemical diagnosis of growth hormone deficiency by growth hormone stimulation testing with either insulin or growth hormone releasing hormone and arginine (GHRH/Arginine).

Required information for members over 18

For members under 18, growth hormone is indicated:

Where there is both laboratory proven human growth hormone deficiency and insufficiency manifested by significant growth retardation (required information); or
Where there is substantiated Turner's Syndrome or Prader-Willis Syndrome* with significant growth retardation(required information); or
For members with Chronic Renal Insufficiency and End Stage Renal Disease prior to successful transplantation (required information).
If you are transitioning from pediatric to adult treatment, you need to have the required information ready when you call.

If you have questions or wish to initiate a request for prior authorization, please contact Customer Service toll-free at (800) 432-3990.

*effective 1/1/2006 with group anniversaries