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.

Nurse speaking with Family about SKYTROFA

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.

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Be prepared for open enrollment! Use this guide to learn how to ask the right questions, compare different plans, and evaluate growth hormone costs and coverage.

For any questions, please call 1-844-442-7236 (available from 8 AM to 8 PM ET, Monday through Friday).

Download guide

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

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How to compare plans

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Open enrollment

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Prior authorizations


More questions? Talk with a member of our support team at 1-844-442-7236.

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."

Michael's story