Weekly versus daily pediatric growth hormone therapy: insurance coverage largely drives selection
By Leah Sherwood
Children with growth hormone deficiency (GHD) may be treated with recombinant human growth hormone (rhGH) to maximize growth from childhood to adulthood, with treatment continuing until growth potential is achieved, often through adolescence or until growth plates close.
Traditionally, the replacement hormone administered is somatropin, a short-acting rhGH that is a synthetically manufactured genetic copy of the natural human growth hormone produced in the pituitary gland. Somatropin is administered via daily subcutaneous injections in doses that are based on weight, usually 0.16–0.3 mg/kg per week, divided into daily doses.1
Somatropin is available in multiple delivery devices, depending on the brand. The traditional injection method, involving syringes and vials, requires manual mixing and drawing up the dose, which can be inconvenient for daily use in a pediatric setting. A more common and user-friendly format is the prefilled pen, including the Genotropin Pen, HumatroPen, and Norditropin FlexPro, which use pre-filled cartridges, simplifying mixing of the somatropin and diluent. Some pens also offer auto-injection features such as push-button activation, which eliminates the need to manually push the plunger.
More recently, alternatives to daily somatropin have emerged: long-acting recombinant rhGH therapies that can be administered once weekly instead of daily. These include Skytrofa® (lonapegsomatropin-tcgd),2 Ngenla™ (somatrogon-ghla),3 and Sogroya® (somapacitan-beco).4 The first 2 therapies are primarily for pediatric GHD, while somapacitan is mainly for adults but has pediatric approvals in some regions.
From a clinical perspective, the new longer-acting drugs offer a potential benefit in terms of adherence, since weekly rather than daily dosing has the potential to improve adherence among pediatric patients compared with daily injections.5
Once GHD is diagnosed, the choice between daily or weekly treatment is frequently governed by insurance coverage and other access considerations rather than clinical ones.
Insights From the Field
To shed light on these issues, Rare Disease 360 spoke with 2 endocrinologists from different institutions—Kathleen Bethin, MD, PhD, of the University at Buffalo and Oischei Children’s Hospital, and Bethany Auble, MD, of Children’s Wisconsin—to discuss their approach to treating GHD. Both emphasized that insurance coverage plays a large role in what they are able to offer their patients.
“Once we diagnose GHD, we are often limited by the therapy based on what is on the insurance formulary,” said Dr. Auble. “I ask my growth hormone coordinator, ‘What’s on the formulary?’ Depending on the commercial insurance or our state Medicaid, she will give me a laundry list.”
Dr. Bethin agreed that access is usually governed by insurance coverage and lamented the “rigamarole that insurance companies make us go through” to get the approval for growth hormones, including supplying literature that supports their use.
“Every year, we’re filling out this prior authorization and answering all the questions of the insurance company,” she said. “Then if the insurance company decides that they’re no longer covering this brand, we have to do a prior authorization for the brand that they are covering. It’s just a lot of work for us.”
Once she identifies the insurance options, Dr. Auble follows a shared decision-making model with the family.
“I will say, ‘We can do a nightly growth hormone preparation, or you have the option for a weekly formulation,’” Dr. Auble shared. “‘Which do you think would be better for your child? Which would help you stay on schedule?’”
Dr. Bethin agreed that some of her patients prefer either the daily or weekly formulation based on scheduling considerations.
“For some people, it’s a hardship to do daily injections and they’d rather do the weekly injection,” Dr. Bethin noted. “On the other hand, you’re more likely [to] get into a routine with daily injections, and with the weekly, you could be forgetting unless you’re putting it on a calendar or have some other reminder.”
Dr. Auble also warns parents that the weekly delivery contains a larger volume of medication to be injected under the child’s skin, which can make the injection more painful. She has also observed that certain patients find certain formulations more or less painful than others, regardless of whether they are administered daily or weekly.
“I would give some patients this brand of growth hormone, and they’d say, ‘That was great; I didn’t feel that injection at all,’” Dr. Auble said. “But then I’d change to a different brand, and they’d say, ‘Ouch, that one really stung,’ even though the next patient would say the opposite.”
For children who find the injections painful, Dr. Auble recommends products like ShotBlocker and Buzzy, which are designed to reduce needle injection pain by applying gentle pressure or distraction at the injection site. The devices work by stimulating nerve endings around the area, making the brain less aware of the needle.
When given the option, most families prefer the weekly dosing, according to Dr. Auble.
“Patients tend to choose the weekly by a wide margin because it’s a little bit easier to navigate, a little bit easier to sell to your child as it’s only once a week shot,” Dr. Auble said. “However, some families don’t have that option because our state Medicaid only chooses the daily formulations.”
Safety and Efficacy Considerations
In terms of safety and efficacy, Dr. Auble said that she feels comfortable prescribing either the daily or weekly formulation.
“The safety is the same,” she noted. “From an efficacious standpoint, the weekly formulation seems to be as good, if not slightly better. There is some data that the weekly is slightly superior in terms of growth velocity, especially over the first 12 months, perhaps half an inch per year.”6
When families are given the opportunity to switch from the daily to weekly treatment, they usually seize it, Dr. Auble noted.
“The vast majority will say, ‘Yes, give me that; I prefer the weekly dose,’” she said. “On the other hand, sometimes patients very much need a regimen and a schedule and a routine, for example, children who have autism, pervasive developmental delays, or ADHD, because the idea of switching to a weekly can be disruptive. Or if they’re nearing the end of therapy, they may say, ‘We really only have a year left, we’re not going to rock the boat.’”
What’s on the Horizon?
Looking to the future, Dr. Bethin noted that an oral treatment may be on the horizon, which would offer a welcome expansion of today’s limited treatment delivery options.
“There is an oral agent that is in clinical trials,” she noted. “I don’t know if it will prove to be effective and safe, but at least there’s a possibility of a daily pill.”
Leah Sherwood is a science writer in Los Angeles.
References
- Grimberg A, DiVall SA, Polychronakos C, et al. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor-I deficiency. Horm Res Paediatr. 2016;86(6):361-397. doi:10.1159/000452150
- Ascendis Pharma. Skytrofa (lonapegsomatropin-tcgd) for injection, for subcutaneous use. Prescribing Information. Revised May 2024. Accessed March 9, 2025.
- Pfizer Inc. Ngenla (somatrogon-ghla) injection, for subcutaneous use. Prescribing Information. Published June 2023. Accessed March 9, 2025.
- Novo Nordisk A/S. Sogroya (somapacitan-beco) injection, for subcutaneous use. Prescribing Information. Published August 2020. Accessed March 9, 2025.
- Gomez R, Ahmed SF, Maghnie M, Li D, Tanaka T, Miller BS. Treatment adherence to injectable treatments in pediatric growth hormone deficiency compared with injectable treatments in other chronic pediatric conditions: a systematic literature review. Front Endocrinol (Lausanne). 2022;13:795224. doi:10.3389/fendo.2022.795224
- Maniatis A, Cutfield W, Dattani M, et al. Long-acting growth hormone therapy in pediatric growth hormone deficiency: a consensus statement [published correction appears in J Clin Endocrinol Metab. 2025:dgaf125. doi:10.1210/clinem/dgaf125.]. J Clin Endocrinol Metab. 2024:dgae834. doi:10.1210/clinem/dgae834
