Plan and pharmacy perspectives: growth hormone therapy, formulary, and benefit authorization.
Overall, third-party payers accept many of the indications for GH therapy. The evidence of pathology in GHD and other causes of short stature are compelling, and the support for improvement in height and metabolic outcomes with GH therapy in most of these disorders is well accepted. To provide well-intentioned coverage and safe and effective treatments to clients who most need it, health plans must do due diligence and ensure that the indications for which they cover rhGH are compelling, beneficial, and safe. Ensuring that those patients who will most benefit from GH therapy do receive treatment may require that unsupported diagnoses are excluded from coverage.
Tzeel
Albert
A
Humana Health Plans of Wisconsin, USA.
Fine
Michael J
MJ
D000328:Adult; D004393:Dwarfism, Pituitary / Q000175:diagnosis; D005569:Formularies as Topic; D013006:Growth Hormone / Q000008:administration & dosage / Q000627:therapeutic use; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D010593:Pharmaceutical Services
D019382:Human Growth Hormone; D013006:Growth Hormone