Pasireotide injection (Signifor LAR)

Signifor (pasireotide) is covered only for adults with Cushing’s disease who are not candidates for pituitary surgery or who have persistent disease after surgery, with no off‑label uses allowed and approval limited to 12 months. Key requirements include documented diagnosis and surgical candidacy status, baseline and periodic safety monitoring (glucose/HbA1c with weekly glucose checks for the first 3 months, ECG/QTc and electrolytes, liver enzymes, gallbladder ultrasound, pituitary function), optimization of antidiabetic therapy before initiation, and documented clinically meaningful reduction in 24‑hour urinary free cortisol and/or symptom improvement for reauthorization; use cautiously in patients at risk for QTc prolongation and monitor/manage hypocortisolism.

"Use with caution in individuals at-risk for QTc prolongation or on drugs that can prolong QT (implies potential exclusion or special monitoring for such patients)."