Diagnosis: Mosaic Turner Syndrome
Treatment: Norditropin Flexpro 15MG (mg/milligrams)/1.5
The insurer denied coverage for Norditropin Flexpro 15MG/1.5.
The denial is upheld.

This is a female diagnosed with Turner syndrome. This request is for Norditropin. As reported, she has mosaic Turner Syndrome with 90% (percent) 45X [sex chromosomes) cells and 10% 46X + isodicentric Y (sex chromosomes) cells and clitoromegaly. She was growing at 5.48 cm/yr (centimeters per year) and was noted to have 2 periods and breast development since starting estradiol. Her current height velocity is reported to be 6.4 cm/yr. Her pubic hair was at tanner 1 and her pubic hair growth/distribution is at Tanner stage 3 with 9 cm (centimeters) bilateral breast diameter, 2.5 cm bilateral areola diameter, and moderate axillary hair.

The Lawson Wilkins Pediatric Endocrine society is the relevant society and the literature, and their recommendations are reviewed here. According to the FDA (Food and Drug Administration) indication [1, 2] and the Lawson Wilkins Pediatric endocrine society [3, 4], recombinant human growth hormone therapy should be initiated as soon as the height of a girl with Turner syndrome falls below the fifth percentile for age [5], which usually occurs between two and five years of age [4]. Early initiation of growth hormone is necessary [6] to achieve normal adult height (159-162cm) [7]. None of these long-term studies showing efficacy of GH (Growth Hormone) in improvement of final height include girls with Y chromosome material or mosaic turner syndrome.

There are no studies showing safety or efficacy of growth hormone in patients such as this patient who has mosaic Turner syndrome and normal stature. The request is not consistent with generally accepted standards of medical practice and is therefore not medically necessary.

The health plan acted reasonably with sound medical judgment in the best interest of the patient.

The insurer's denial of coverage for the Norditropin FlexPro 15mg/1.5 is upheld. Medical Necessity is not substantiated.