SWL Growth Hormone Commissioning Policy

Rationale

There are considerable cost-saving opportunities for rationalising the number of growth hormone products but still giving patients a choice. The London Procurement Partnership (LPP) recommends that regions should co-ordinate to three products unless there are licensing issues. This policy (also available as a visual summary) is informed by:

• Relative cost of growth hormone preparations for London (as of August 2024). NICE states if more than one treatment is suitable (including somatrogon and any preparation of somatropin), the least expensive should be chosen, taking into account administration costs, dosage, price per dose and any commercial arrangements).
• Local prescribing agreements (i.e. shared care prescribing agreement for certain somatropin products, for paediatric patients).
• Sustainability and other factors.
  • Genotropin^® cartridges offer a more sustainable option to disposable Genotropin GoQuick^® pre-filled pens, as the cartridges can be supplied for use in a re-usable injection device (approx. lifespan of 2 years).
  • Genotropin MiniQuick^® and Norditropin Flexpro^® can be stored outside the fridge.
  • Ngenla^® (somatrogon) provides the option of a weekly injection instead of daily injection for paediatric patients.

Recommendations

The recommendations for paediatric patients and adults are summarised below.

• Patients currently on a product not listed below should be reviewed with the aim of switching to a product in line with this policy if considered clinically appropriate.
• Shared care is only supported for the most cost-effective brands of somatropin i.e. Omnitrope^® (1^st choice as the least expensive brand) and Genotropin^® (2nd choice) (based on pricing as at August 2024).
• Shared care is not supported for any other somatropin brand and should not be suggested or accepted.

Paediatric: Shared care or Homecare

1^st choice

• Omnitrope^®
  • Shared care or Homecare
  • Better sustainability

2^nd choice

• Ngenla^® (somatrogon)
  • Homecare only
  • Once weekly dosing versus daily
• Genotropin GoQuick^®
  • Shared care or Homecare
• Norditropin FlexPro^®
  • Homecare only
  • Can be stored outside the fridge
• Genotropin MiniQuick^®
  • Shared care or Homecare
  • Can be stored outside the fridge
• Genotropin^® cartridges for pens
  • Shared care or Homecare
  • Better sustainability

Adults: Home care only

All prescribing of Growth Hormone in adults is by the specialist via Homecare only.

1^st choice

• Omnitrope^®
  • Better sustainability

2^nd choice

• Genotropin GoQuick^®
• Norditropin FlexPro^®
  • Can be stored outside the fridge
• Genotropin MiniQuick^®
  • Can be stored outside the fridge
• Genotropin^® cartridges for pens
  • Better sustainability

Clinical Summary

• NICE TA188 (Human growth hormone (somatropin) for the treatment of growth failure in children) and NICE TA64 (Human growth hormone (somatropin) in adults with growth hormone deficiency) recommend somatropin as a treatment option for children and adults with growth failure associated with conditions listed below.
• Somatrogon is recommended for treating growth disturbance in children and young people aged 3 years and over in NICE TA863. 

For paediatric patients

Omnitrope^® and Genotropin^®

• Growth hormone deficiency
• Chronic renal insufficiency
• Short stature homeobox (SHOX) (off-label use, agreed locally across SWL)
• Small gestational age
• Prader-Willi syndrome
• Turner syndrome

 Norditropin FlexPro^®

• Growth hormone deficiency
• Chronic renal insufficiency
• Small gestational age
• Turner syndrome
• Noonan syndrome (NHSE commissioned specialist centres only, e.g. Evelina Children’s hospital)

Ngenla^® (somatrogon)

• Growth hormone deficiency

For adult patients

Omnitrope^®, Genotropin^®, Norditropin FlexPro^®

• Growth hormone deficiency

v1.0 Approved by: Integrated medicines optimisation committee (IMOC) March 2025