Octreotide Products (Sandostatin, Sandostatin LAR)

Covered only for FDA‑approved acromegaly (non‑oncology); non‑FDA/oncology uses are not supported. Key requirements: baseline IGF‑1 above the lab age/gender ULN, documentation of inadequate response to or ineligibility for surgery/radiotherapy or tumor‑related mass effects, prescription by or consultation with an endocrinologist, adherence to the specified 3‑month initiation/conversion and GH/IGF‑1/symptom‑based dose‑adjustment algorithm (10/20/30/40 mg q4w with >40 mg not recommended), and evidence (serial GH/IGF‑1 and clinical notes) to justify 12‑month authorization and reauthorization.

"Drug approval duration is limited to 12 months per authorization."

Sign up to see full coverage criteria, indications, and limitations.