Appropriate Use of Growth Hormone Therapy in Adults: A Collaborative Approach

The AmericanJournal of Managed Care

AppropriateUse of Growth Hormone Therapy inAdults: A Collaborative Approach to DeliverEffective Patient Care

This supplement to providesthe highlights of a roundtable, , held in Phoenix,Arizona, February 5-7, 2004. The roundtablefaculty was composed of experts inadult and transitional endocrinology andkey representatives of the managed carepayer community. These experts provided aunique and valuable perspective on theevolving role of recombinant human growthhormone (hGH) in patients transitioningfrom pediatric therapy and adults initiatingtreatment. Also, the practical managedcare issues–formulary management, diagnosisand treatment, and reimbursementpolicies–that influence prescribing practicesfor these patient groups were discussedin detail. Growth hormonedeficiency (GHD) in adults and transitionalpatients represents a distinct diseaseentity from pediatric GHD that is associatedwith a myriad of metabolic disturbancesthat can increase the risks for cardiovasculardisease and premature mortality.

Implementing OptimalGuidelines for Growth Hormone Use ina Managed Care Population

These proceedings are a follow-up to aMarch 2000 roundtable, , which focusedprimarily on the use of hGH in pediatricpatients. The roundtable presented in 2000,which included a panel of experts inendocrinology and managed care, concludedthat traditional pediatric indications forhGH were well accepted and covered bymost healthcare plans. Further, the 2000roundtable panel identified the transitionalpatient as an area of concern requiring additionaldiscussion. Although not all pediatricpatients requiring hGH therapy will need tocontinue therapy into adulthood, a clinicallymeaningful proportion will.

The 2004 roundtable focused on the currentprovider and payer issues that continueto surround the use of hGH in adults andtransitional patients. The roundtable examinedand discussed:

• Balancing ethical and economic issues inthe management of GHD in adults
• Reimbursement issues and future trendsin prescription benefit design and theirimpact on hGH delivery
• Diagnostic and treatment issues in themanagement of GHD in adults

This roundtable program comprised formalpresentations by medical, pharmacy,managed care, and benefit design experts,case history discussions, and group discussionsto capture both provider and payerperspectives.

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