- Prior Authorization: Growth Hormone Deficiency:
PA Applies
HIV Wasting:
Medical Test Required: Yes
Duration: 3 Month(s)
Reauthorization Required: Yes
- Growth Hormone Deficiency:
Reauthorization Required: No
Duration of Reauthorization: N/A
Pediatric - GH Stimulation Test: N/A
Pediatric - Pituitary Hormone Deficiency: N/A
Adult - GHD Stimulation Test: N/A
Adult - Pituitary Hormone Deficiency: N/A
Adult - Duration of Initial Authorization: N/A
Adult - Duration of Reauthorization: N/A
Documented Diagnosis of Other Approved Indications: AIDs/HIV Associated Wasting or Cachexia
Documented Diagnosis: No
HIV Wasting:
Duration: 3 Month(s)
Documented Diagnosis: No
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
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