Nutropin AQ or Nuspin Health Insurance Denial

• Received a Nutropin AQ or Nuspin Health Insurance Denial? Contact Us
• How Does Nutropin AQ Work?
• What Are Other Similar Drugs to Nutropin AQ?
• Understanding the Differences Between Biologic Drugs and Biosimilar Drugs
• Is There a Biosimilar Drug for Nutropin AQ?
• Do Insurance Companies Cover Growth Hormone Biologics?
• How do Insurance Companies Evaluate Growth Hormone Coverage Requests?
• What Duty Do Insurance Companies Have to Members Submitting Claims?
• Contact the Law Offices of Scott Glovsky if You Receive a Growth Hormone Deficiency Drug Health Insurance Denial

Received a Nutropin AQ or Nuspin Health Insurance Denial? Contact Us

Nutropin AQ (somatropin) is a human growth hormone medication, while NuSpin is a type of injection device used to administer Nutropin AQ. Nutropin AQ is the medication, while NuSpin is the device that delivers the medication. Nutropin AQ and NuSpin received initial FDA approval on December 29, 1995. Protropin (somatrem) was the only FDA-approved recombinant human growth hormone approved earlier than Nutropin AQ. 

In 1985, this was a significant advancement, as prior to this, human growth hormone was obtained from human cadaver pituitary glands. Nutropin AQ NuSpin is a prefilled, disposable, multi-dose device containing Nutropin AQ, used to treat growth failure. Genentech, the manufacturer of Nutropin AQ, announced the discontinuation of Nutropin AQ (somatropin) NuSpin formulations in the United States on December 31, 2024. 

According to Genentech, the decision was based solely on business considerations, rather than safety or efficacy issues, and the wide availability of alternative growth hormone options. Those taking Nutropin AQ NuSpin formulations should consult their healthcare professionals to discuss alternative options. This article will discuss potential substitutes for Nutropin AQ NuSpin and outline how insurance companies determine medical necessity. If you have received a health insurance denial for a growth hormone medication, contact the Law Offices of Scott Glovsky. 

How Does Nutropin AQ Work?

Nutropin AQ is a form of human growth hormone that works by mimicking the actions of the body’s natural growth hormone to promote growth, development, and balanced metabolism. Nutropin AQ utilizes recombinant DNA technology to replace or supplement the natural growth hormones typically produced by the pituitary gland. 

The drug stimulates various bodily processes in children with growth failure, such as skeletal growth, cell growth, organ growth (particularly the kidneys), and increases red blood cell mass. The drug stimulates protein synthesis, carbohydrate metabolism, lipid metabolism, and mineral metabolism (linked to cellular growth and bone growth) as well. 

What Are Other Similar Drugs to Nutropin AQ?

There are other somatropin drugs that are recombinant human growth hormones, like Nutropin AQ, used to treat growth failure due to inadequate secretion of growth hormone in children or growth hormone deficiency in adults. These drugs include:

• Genotropin
• Humatrope
• Norditropin
• Omnitrope
• Saizen
• Zomacton
• Skytrofa (lonapegsomatropin-tcgd, a long-acting somatropin)
• Sogroya (somapacitan-beco, another long-acting somatropin)

While these drugs share the same active ingredient or a related one, there can be differences in formulations, dosages, and side effects. While Nutropin AQ comes with NuSpin as a solution for injection, other formulas, such as Humatrope, are available as an injectable powder. 

On its website, UnitedHealthcare details specific insurance plans along with the “preferred alternative growth hormone” to Nutropin AQ. For those with UnitedHealthcare Commercial Plans, Norditropin and Omnitrope are the preferred alternatives to Nutropin HQ. 

For those on UnitedHealthcare Individual Exchange plans, Omnitrope is the preferred alternative. For those on a UnitedHealthcare Community Plan, the preferred alternative medication is Norditropin or Omnitrope. For UnitedHealthcare Medicare Advantage and Part D Plan members, Genotropin is the preferred alternative to Nutropin AQ.  

Understanding the Differences Between Biologic Drugs and Biosimilar Drugs

Nutropin AQ, like the other drugs listed above, is a biologic drug. Biologics contain substances created by using living cells or organisms. Some examples of biologics include stem cell therapies, gene therapies, transplant tissues, and monoclonal antibodies. Biologic drugs are used to treat severe, often life-threatening diseases. Biologics typically cost considerably more than small molecule drugs due to their structural complexities, the complexity of manufacturing processes, the sourcing of materials, and stringent regulatory requirements. 

Biosimilar drugs are a class of medications designed to increase access for patients who require a biologic medication. A biosimilar drug has no meaningful differences from an existing biologic, known as the “reference product.” The biosimilar is just as safe, pure, and effective as the original. Although biosimilar drugs, like biologics, undergo rigorous testing and evaluation and must meet the same manufacturing standards, the approval process is usually more streamlined.  

Is There a Biosimilar Drug for Nutropin AQ?

Omnitrope is considered a biosimilar recombinant human growth hormone for Nutropin AQ and was approved by the European Medicines Agency in 2006, and by the FDA in the United States. The general formulation patent for Nutropin AQ expires in 2027, while the patents covering the formulation and composition of Nutropin Depot expired in 2014.  

Do Insurance Companies Cover Growth Hormone Biologics?

Insurance typically covers growth hormone biologics, particularly for children with growth hormone deficiency, although the coverage levels can vary significantly, depending on your specific plan. Children born with low birth weight who experience slow growth, children with severe kidney disease and poor growth, and children with short stature who have syndromes like Turner syndrome, Noonan syndrome, and Prader-Willi syndrome are usually able to have their insurer cover growth hormone biologics. 

Documentation of the condition is crucial; you will need a confirmed diagnosis of growth hormone deficiency or a related condition, documentation of medical necessity, and, in some cases, evidence of failed alternative treatments (known as step therapy). Many insurers require prior authorization before covering growth hormone therapy, which often involves a review process by the insurer. Because growth hormone therapies are expensive (monthly costs can range from $1,000 to $5,000), insurance companies sometimes make the approval process difficult. 

Government health insurance programs like Medicaid and Medicare will likely pay for treatments similar to Nutropin AQ. Medicaid allows low-income individuals and families to have health insurance when they otherwise could not afford it. Medicare is for those over the age of 65, and prescription drug coverage may be through Medicare Advantage Plans (Part C) or Supplemental Plans (Part D). Prescription drug coverage is not automatic through Medicare; patients must enroll separately. 

Commercial private insurance companies like Kaiser Permanente, Anthem, Aetna, UnitedHealthcare, Medi-Cal Managed Care Plans, Healthnet, and Blue Shield hold different coverage standards. Many private insurance plans may cover growth hormone drugs similar to Nutropin AQ, but some may attempt to deem the drug not medically necessary, experimental, or investigational to avoid paying for the drug. 

How you appeal a claim denial for human growth hormone drug will depend on whether you have an ERISA (Employment Retirement Income Security Act of 1974) or a non-ERISA plan. Most private employers (with some exceptions listed below) provide their employees with ERISA plans.  

• Business plans that only cover business owners
• Religious organization plans
• Individual and family plans through Covered California
• Government employee plans
• Individual and family plans purchased through private insurance companies like Anthem Blue Cross or Blue Shield of California.  

How do Insurance Companies Evaluate Growth Hormone Coverage Requests?

Internal medical or pharmacy policies dictate coverage requests through health insurers. When the FDA approves a new drug, insurers have their pharmacists and other practitioners research the drug and develop internal clinical policies, which are then reviewed and approved by an external group of doctors. 

Unfortunately, there may be incentives for the doctors to vote in a way that benefits the insurance companies, whether through financial incentives or promises of employment. This can lead to overly restrictive policies that deny coverage for medically necessary drugs. Prior authorization and step therapy may be required before coverage for a growth hormone drug is approved. 

What Duty Do Insurance Companies Have to Members Submitting Claims?

Whether a claim is submitted for a drug or a treatment, the insurer will review the claim and make a determination as to whether the claim is approved or denied. The insurance company has several duties in this process:

• The insurance company has a duty to thoroughly investigate claim requests. 
• The insurer must fully inquire into all reasons that might support the request for care. 
• The insurance company has a duty to respond promptly to claim requests. 
• The insurer has a duty to appoint and employ qualified medical professionals to make claim review decisions.   

Contact the Law Offices of Scott Glovsky if You Receive a Growth Hormone Deficiency Drug Health Insurance Denial

Attorney Scott Glovsky and the Law Offices of Scott Glovsky have represented injured consumers and victims of wrongful business practices since 1999. Scott is passionate about helping policyholders obtain treatments, coverage, and reimbursements; he and his team have consistently fought for justice for injured consumers and victims of wrongful business practices. Our firm focuses on health insurance bad faith, other type of insurance bad faith, catastrophic personal injury, sexual abuse, and consumer-related litigation. If you believe large insurance companies should be held accountable, call the Law Offices of Scott Glovsky today.