Growth Hormone (GH) and Growth Hormone Antagonists

Aetna covers somatropin products for pediatric growth hormone deficiency (neonatal diagnosis with supporting records or either two provocative GH tests with peak <10 ng/mL or documented pituitary/CNS disorder plus pretreatment IGF‑1 ≥2 SD below mean), and for SGA (≥2 years with failed catch‑up growth), Turner syndrome (karyotype confirmed), growth failure from CKD, cerebral palsy, congenital adrenal hyperplasia, cystic fibrosis, Russell‑Silver syndrome, and Prader‑Willi (genetic confirmation). Key requirements/limits: precertification required for Serostim/Somavert, epiphyses must be open, product age/weight restrictions apply (somapacitan ≥2.5 yrs; Skytrofa ≥1 yr and ≥11.5 kg; SGA ≥2 yrs), adult GHD needs specified provocative test thresholds (eg ITT ≤5 ng/mL; Macimorelin only if other tests contraindicated, BMI ≤40, endocrinologist prescriber, 0.5 mg/kg dose limit), and other height/velocity testing criteria per policy.

"E88."