Does insurance cover growth hormone shots?

amother

Gladiolus

Wed, Feb 14 2024, 6:46 pm

amother Blush wrote:

I would imagine that if she is not growth hormone deficiency then it is not medically indicated. Why would insurance pay for medication not medically indicated.

(Even if you want /believe it would help, insurance shouldn’t pay for it, just as they shouldn’t provide me with Ozempic if I am 35lb overweight with no co-morbidity)

It's very much dependent on the insurance company. It may help you to find an advocate to get you approved.

I don't know what the test is called, but it's a three hour test that measures growth hormone levels more comprehensively than a regular blood test. DC's growth hormone levels were regular on the regular blood test but they found deficiencies in the more comprehensive test. You may want to push to have that done.

A year behind in bone age is neither here nor there because from what I understand the reading can be a year off either way.

But you should go to a pediatric endroconolgist to explain this to you and help navigate.

If you're in the Lakewood area, I highly recommend Dr. Craig Alter from CHOP, and yes we paid out of pocket to see him.

amother

Yellow

Wed, Feb 14 2024, 7:36 pm

amother Foxglove wrote:

As far as I know, In the UK they don't give GH to kids who aren't deficient because the risk of side effects outweighs the benefit.
Did she have any genetic tests done? Specifically SHOX micro deletion and and Russel silver syndrome. They cause short stature but normal growth hormone levels. Growth hormones have been proven to help. Also did she test for celiac? It can cause short stature as the only symptom. My son had this. We only found out due to his tiny size. But he is also growth hormone deficient.

Same for my niece

amother

Darkblue

Wed, Feb 14 2024, 8:00 pm

I found some drs on manhattan were able to get my private insurance to approve growth hormone shots for idiopathic short stature even if the stim test did not show growth hormone deficiency. We needed to do a lot of testing first. We did it because his drs felt it would help a little. If it helped it was very little. But insurance did cover it while my ds was doing this.

amother

Currant

Fri, May 03 2024, 6:16 am

amother Darkblue wrote:

Same. My child didn't have growth hormone deficiency and was diagnosed with idiopathic short stature and the insurance covered the growth hormone for all the years he needed since his growth rate was extremely low. His doctor was very persistent with the insurance company. However before that, the previous insurance we had denied the treatment but we were able to get the growth through a patient assistance program through the pharmaceutical company that produced the growth hormone. There is also a copay card program that some offer and that could bring down the cost to only $5 per month.

amother

Banana

Fri, May 03 2024, 7:44 am

amother Amber wrote:

My 11 year old son isn't gh deficient not on the charts for his height doctor said he won't get approved. I'm looking for a second opinion . Anyone knows a doctor who would fight for insurance to cover?

For boys talk to your endocrinologist about Anastrozole.

My ds wasn't deficient, bone scanned showed that he was 1.5 years delayed. We did the bone scan annually and followed up with the endocrinologist. After 2 years the scans changed and showed his true age. His expected height was 5ft.

Ds took Anastrozole for a fee years. Bh he is 5"5 now.

amother

Geranium

Fri, May 03 2024, 7:49 am

amother Blush wrote:

You’re attributing too much reasonability to insurances. I am overweight and have hypertension. I should qualify for Ozempic, but my insurance requires I fail two other lines of therapy before they pay for it first. Commercial insurance through my employer (a hospital).

amother

Daffodil ↓

Fri, May 03 2024, 9:46 am

We did this for my DC. Had to do a bone scan, a regular blood test (for celiac and growth hormone) and then had to get approved for the stim test. Took way more than 3 hours BTW.
Then brain MRI.
Then approved. We had commercial insurance at the time. But we ended up on our states medicaid for a month (job loss) and they paid.

You have to prove need and eligibility.

amother

↑ Daffodil

Fri, May 03 2024, 9:50 am

amother Geranium wrote:

Right, this is standard for fancier or more expensive drugs. We needed to try growth hormone A and fail it before we could get B approved. We had an issue because A was backordered and was unavailable. I had to call the insurance company and explain that it was unavailable (I had called manufacturer) so I couldn't have DC try and fail a med that doesn't exist right now to try! Then they gave a short term approval for a different medication that was more expensive but available.
I have had the same thing with other meds. It depends on insurance formulary which is tier 1 vs 2. When you fail enough tier 1 they cover tier 2 (but sometimes with higher copay).