HMOs differ in their policies on reimbursement for growth hormone prescriptions. Even with one city, policies range from full reimbursement, to 50% co-pay, to no reimbursement. Presently, decisions are made on a case by case basis, relying on a wide range of criteria. These include FDA approval for the indication, opinions by clinical experts, literature review of likely benefit, definition of disease, cost, availability of alternatives, concerns about adverse selection, whether employers are willing to purchase coverage, whether the treatment is investigational, and whether it is a "medical necessity" - although the definition of that term is unclear.
|Original language||English (US)|
|Issue number||4 SUPPL.|
|Publication status||Published - 2001|
ASJC Scopus subject areas