Growth Hormone Therapy Insurance Coverage
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Growth hormone is expensive and requires coordination among your insurance company, Endocrinology Clinic, pharmacy and drug manufacturer.
Because growth hormone is very expensive, insurance companies require an authorization before your child can get the medicine.
To be covered by insurance, your child must also meet the insurance company’s clinical criteria for growth hormone.
How do we start growth hormone therapy?
The process generally involves the following steps, but it may be different for your child:
1. Diagnosis
Your child’s doctor recommends or orders growth hormone therapy for your child. They do this by sending a request to the growth hormone nurses to start the prior authorization process.
2. Growth hormone brand selected
We will see which brands your insurance company covers. We will let you know if you need to make a choice between brands, but usually the insurance company decides on 1 brand.
3. Insurance authorization
Once the brand is chosen, our clinic completes a prior authorization request with your insurance company or pharmacy benefit manager. We will then fill out required paperwork and send it to the manufacturer support service company.
This process can take up to 4 weeks to complete.
4. Appeal letter (if needed)
In some cases, the insurance company may deny coverage. Depending on the reason for the denial, your child’s doctor may write an appeal letter. The appeal process can take anywhere from 4 weeks to 3 months to complete.
Will we have to continue to get authorizations?
Yes. Most insurance companies require an authorization every 3 to 12 months. Some insurance companies require authorization each time the doctor increases the growth hormone dose.
Call or email our office 1 month before the end of your current authorization so we can start the process of getting the authorization again. This is an important step to help us ensure your child gets the care they need.
Who is involved in getting my child’s medicine?
Your insurance company
They authorize the medicine and determine which brand of growth hormone your child will use.
Pharmacy benefit manager
Sometimes your insurance company may work with a pharmacy benefit manager. They are responsible for processing and making the final decision about our authorization request.
A manufacturer support services company
Each brand of growth hormone medicine has a support company. These companies register you into their support program, send you a starter kit with supplies, offer copay assistance if you qualify, and offer other services depending on the company and your medicine.
A specialty mail-order pharmacy
After your insurance company has chosen a pharmacy as their preferred pharmacy, you must order your child’s growth hormone medicine directly from them. The pharmacy will send either 1- or 3-month shipments of the medicine to your home. Your insurance will decide if the shipments will be 1- or 3-month supplies. Your child’s care team and the pharmacy cannot change this process.
Does it matter which growth hormone brand my child gets?
No. All brands have the same concentration of the growth hormone medicine. The only difference between the brands is the delivery device and sometimes the preservatives they use to keep the drug stable. Your insurance decides which brand your child will get.
How can I help with ongoing authorizations?
If your insurance changes
Call or email us as soon as you know about the changes. Send us a copy of both sides of your insurance card and your pharmacy benefits card (if you have one). We will start the prior-authorization process.
If you do not have any changes in insurance
Call or email us about 1 month before your current approval ends.
To Learn More
- Endocrinology
206-987-2640 - Ask your child’s healthcare provider
- seattlechildrens.org/patient-education
Free Interpreter Services
- In the hospital, ask your nurse.
- From outside the hospital, call the toll-free Family Interpreting Line, 1-866-583-1527. Tell the interpreter the name or extension you need.
