Human Growth Hormone (GH)

This policy covers prescription human growth hormone (GH) therapy for FDA‑approved indications and select off‑label uses supported by standard compendia or at least two qualifying peer‑reviewed articles, including pediatric growth hormone deficiency, short stature (e.g., SGA children who fail to catch up by age 2, height SDS ≤ −2.25), neurosecretory GH dysfunction, constitutional growth delay, and adjunctive use with GnRH analogues. Coverage is subject to member benefit plan, formulary status and state rules; major limitations include denial for GH in older adults without documented GHD, anabolic/body‑enhancement uses or certain catabolic conditions, FDA‑contraindicated or non‑formulary uses, and requirements for robust clinical evidence (not case series); self‑injectables are processed under the pharmacy benefit.

"Coverage of an FDA‑approved drug when prescribed for a use recognized as safe and effective in one or more standard medical reference compendia adopted by HHS."