CHALLENGES OF SECURING GROWTH HORMONE COVERAGE FOR IDIOPATHIC SHORT STATURE: REVIEW OF THE 7 YEAR EXPERIENCE AT ONE INSTITUTION.

BACKGROUND: Despite FDA approval of growth hormone(GH) for idiopathic short stature(ISS), many providers face challenges obtaining insurance coverage. We reviewed the insurance coverage experience for ISS at our hospital to identify factors predictive of approval or denial.

METHODS: We reviewed charts of patients who underwent GH stimulation testing from 07/01/09 to 04/30/17 to identify ISS patients (height <-2.25SD, subnormal predicted adult height(PAH) and peak GH >10ng/ml) Results: 87 patients met ISS criteria, of whom 47(29M/18F) had GH request submitted to insurance. Mean age, height and growth velocity were 8.6±2.7years, -2.83±0.4SD and 4.4±1.7cm/yr respectively. Mean PAH based on bone age was -2.50±0.9SD, equaling 62″for males and 58″ for females. Most had private managed care insurance (74%). 17/47(36%) received treatment approval, 7 immediately and 10 more on appeal. There were no differences in age, height SD, growth rate, insurance type or PAH between the 17 who were approved and the 30 denied. For 21 patients who were treated, a mean increase in 0.6 SD in height was seen after one year.

CONCLUSION: At our institution, GH coverage requests for ISS included very short children mostly ages 6-11, with heights well below -2.25 SD and poor PAH. Only 36% were approved even after appeal. This highlights the challenge in our area to secure GH treatment for a FDA approved indication. Collaboration between pediatric endocrinologists and insurers focusing on height SD and PAH, may improve cost-effective coverage to deserving short children who meet FDA guidelines for ISS treatment.

ABBREVIATIONS: ISS = idiopathic short stature; GH = growth hormone; PAH = predicted adult height; FDA = Food and Drug Administration ; IGF-1 = insulin-like growth factor 1.