SKYTROFA is now FDA approved for adults with growth hormone deficiency Learn More
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Understanding your
insurance options

Choices matter when it comes to health insurance plans. It is important to carefully consider every option to find the best coverage for your child's specialty medication needs.
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SKYTROFA is now covered by more insurance plans. Are you covered?

If your doctor has already prescribed SKYTROFA, call 1-844-442-7236 to check your coverage.

If your doctor is still considering SKYTROFA, find out what your plan covers by exploring the topics below.


Insurance Coverage Q&A

Questions about coverage? We have the answers. Explore some important insurance coverage topics from the “Navigating Coverage and Insurance Trends” video below.

What are the primary types of health insurance available?

Health insurance comes in many forms:

  • Group-sponsored Health Insurance: Offered through employers or spouse/domestic partner's employer.
  • Private Coverage: Directly purchased from insurance carriers.
  • Exchange Plans: Purchased through state or federal exchanges, with possible subsidies based on income.
  • Medicare: A federal program for individuals aged 65 and older.
  • Medicaid and Children's Health Insurance Program (CHIP): Available for qualifying individuals with disabilities or conditions.
What are the main categories for insurance plans?

Health insurance plans can be classified into 4 primary categories, each with its own set of features:

  1. Health Maintenance Organization (HMO): Limited to in-network providers, requires a primary care physician (PCP), and referrals for specialists.
  2. Exclusive Provider Organization (EPO): Restricts care to in-network providers but doesn't require a PCP or referrals.
  3. Point of Service (POS): Allows both in-network and out-of-network care, but PCP and referrals are needed.
  4. Preferred Provider Organization (PPO): Provides in-network and out-of-network coverage without requiring a PCP or referrals.
What is the difference between fully insured and self-funded health plans?

With a fully insured plan, the employer pays a fixed monthly premium to an insurance company, covering plan administration and claims. The insurance company bears the loss if claims exceed expectations.

With a self-funded plan, the employer pays a monthly fee to an insurance company for administration and claims adjudication but covers the actual claims costs. The employer benefits if costs stay below expectations and has more flexibility in plan features.

How can I manage rising costs for prescriptions?

Health insurance companies use various strategies to manage specialty medication costs, including prior authorizations and step therapy. Stay informed about new trends, such as co-pay accumulators, and explore financial assistance programs.

Watch the New Rx Trends chapter in the video below for more details.

How can I find out what my plan covers?

To understand your coverage, review the Summary of Benefits and Coverage (SBC) provided by the insurance company. It outlines co-pays, deductibles, and out-of-pocket maximums.

For detailed coverage information, you can get the medical policy from the insurance company's website or call their Member Services department.

What should I consider during open enrollment?

During open enrollment, consider the following factors to make the best decisions for your family's healthcare needs:

  • Estimate your annual expenses, including co-pays, coinsurance, deductibles, and out-of-pocket maximums.
  • Compare total costs of different plans, including in-network and out-of-network expenses.
  • Check if your prescriptions, especially growth hormone medications, are covered similarly in each plan.
  • Attend open enrollment events, ask questions, and seek assistance to understand any changes to the plan.
What should I know about prior authorizations and appeals?

Be proactive in the prior authorization and appeals process by documenting all communications between you and your insurance company.

If you face a denial, involve your child's doctor, focus on medical necessity, and provide evidence to support your appeal. Always advocate for yourself and your family to get the medicine you need!

What additional resources are available?

Various advocacy organizations offer support and educational resources. Seek assistance and advocacy to ensure you have access to the best healthcare options.

Click here to explore some of these organizations and more GHD resources.

Watch this video titled “Navigating Coverage and Insurance Trends” to learn about:

1
How to compare plans
2
Open enrollment
3
Prior authorizations
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Real caregiver of child with GHD

Meet Michael

Michael first noticed the height difference between his son, Kevin, and his peers at school. They hope to share their SKYTROFA story with other "late bloomers."

IMPORTANT SAFETY INFORMATION & USES

SKYTROFA is a prescription medicine used for:

  • the replacement of growth hormone in children 1 year old or older who weigh at least 26 pounds (11.5 kilograms) with growth hormone deficiency (GHD)
  • the replacement of growth hormone in adults with growth hormone deficiency (GHD)

Do not take SKYTROFA if:

  • you have a critical illness caused by certain types of heart or stomach surgery, trauma or breathing problems
  • you are allergic to somatropin or any of the ingredients in SKYTROFA

IMPORTANT SAFETY INFORMATION & USES

SKYTROFA is a prescription medicine used for:

  • the replacement of growth hormone in children 1 year old or older who weigh at least 26 pounds (11.5 kilograms) with growth hormone deficiency (GHD)
  • the replacement of growth hormone in adults with growth hormone deficiency (GHD)

Do not take SKYTROFA if:

  • you have a critical illness caused by certain types of heart or stomach surgery, trauma or breathing problems
  • you are allergic to somatropin or any of the ingredients in SKYTROFA
  • you are a child with closed bone growth plates
  • you have cancer or other tumors
  • you have certain types of eye problems caused by diabetes
  • you are a child with Prader-Willi syndrome who is severely obese or has breathing problems including sleep apnea (briefly stopping breathing during sleep)

Tell your healthcare provider if you are pregnant or plan to become pregnant, about all of your medical conditions, and about all the medicines you take. SKYTROFA may affect how other medicines work, and other medicines may affect how SKYTROFA works.

What are the possible side effects of SKYTROFA?

SKYTROFA may cause serious side effects, including:

  • serious allergic reactions. Get medical help right away if you have swelling of the face, mouth, tongue, or throat or trouble breathing
  • high risk of death in people who have critical illnesses caused by heart or stomach surgery, trauma, or serious breathing problems
  • increased risk of growth of an existing tumor or cancer, or increased risk of a previous tumor or cancer returning in people who were treated with radiation to the brain or head as children and who developed low growth hormone problems. Your healthcare provider will need to monitor for the growth or return of a tumor or cancer. Contact your healthcare provider if you start to have sudden changes in behavior, headaches, vision problems, or changes in moles, birthmarks, or skin color
  • new or worsening high blood sugar or diabetes. Your blood sugar may need to be monitored during treatment with SKYTROFA
  • increase in pressure in the skull. Contact your healthcare provider if headaches, eye problems, nausea, or vomiting occur
  • too much fluid in the body (fluid retention). Contact your healthcare provider if you notice swelling in the hands and feet, pain in the joints or muscles, or nerve problems that cause pain, burning or tingling in the hands, arms, legs, and feet
  • decrease in a hormone called cortisol. Your healthcare provider will do blood tests to check your cortisol levels
  • decrease in thyroid hormone levels. Decreased thyroid hormone levels may affect how well SKYTROFA works. Your healthcare provider will do blood tests to check your thyroid hormone levels
  • hip and knee pain or a limp in children (slipped capital femoral epiphysis). This may lead to a serious condition where bone tissue dies due to a lack of blood supply (osteonecrosis). Get medical help right away for children who develop a limp or have hip or knee pain
  • worsening of curvature of the spine in children (scoliosis)
  • severe and constant abdominal pain. This could be a sign of pancreatitis. Tell your healthcare provider about any new abdominal pain
  • loss of fat and tissue weakness in the area of skin you or your child inject. Talk to your healthcare provider about rotating the areas where SKYTROFA is injected
  • high risk of sudden death in children with Prader-Willi syndrome who are severely obese or have breathing problems, including sleep apnea
  • increase in phosphate, alkaline phosphatase, and parathyroid hormone levels in your blood. Your healthcare provider will do blood tests to check this

The most common side effects of SKYTROFA in children include: viral infection, fever, cough, nausea and vomiting, bleeding, diarrhea, stomach area pain, joint pain and arthritis

The most common side effects of SKYTROFA in adults include: swelling due to fluid build-up and low thyroid hormone

These are not all of the possible side effects of SKYTROFA. Call your doctor for medical advice about side effects. You are encouraged to report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. You may also report side effects to Ascendis Pharma at 1-844-442-7236.

Please click here for SKYTROFA full Prescribing Information.