Limited coverage criteria – somatropin

Generic name

somatropin

Brand name

Strength

Form

Genotropin^®

5.3 mg, 12 mg / pen (GoQuick^™); 0.6 mg, 0.8 mg, 1.0 mg, 1.2 mg, 1.4 mg, 1.6 mg, 1.8 mg, 2.0 mg

syringe (MiniQuick^™)

Humatrope^®

5 mg / vial; 6 mg, 12 mg, 24 mg

cartridges

Nutropin AQ^®

10 mg / cartridge (Pen^®); 5mg, 10mg, 20mg

cartridge (NuSpin^®)

Omnitrope^®

5 mg, 10 mg, 15 mg / cartridges

cartridges

Saizen^®

3.33 mg, 5 mg / vials; 8.8 mg / vial (click.easy^®); 6 mg, 12 mg, 20 mg

cartridges

Norditropin^® NordiFlex^™

Norditropin^® Flexpro^™

5 mg, 10 mg, 15 mg

prefilled pen

For patients 20 years and younger, when a Special Authority request is submitted by:

• Endocrinologist at the BC Children's Hospital for true growth hormone deficiency

OR 

• Nephrologist for chronic renal insufficiency