Octreotide acetate injection (Sandostatin LAR Depot, Sandostatin)

Covered: Octreotide acetate (Sandostatin LAR Depot and Sandostatin) for the FDA‑approved non‑oncology indication of acromegaly (inadequate response to or ineligibility for surgery/radiotherapy, or tumor mass effects); non‑acromegaly/oncology uses are excluded. Key requirements: baseline IGF‑1 above the lab ULN, prescription by or consultation with an endocrinologist, documentation of diagnosis and prior surgery/radiotherapy status or tumor effects, specified initial dosing (50 mcg SC TID x2 weeks then LAR 20 mg q4w, or 20 mg q4w for current SC users), mandatory 3‑month biochemical/clinical reassessment with GH/IGF‑1–guided dose adjustments (10–40 mg q4w), 12‑month approval duration, and doses >40 mg q4w not recommended.

"Sandostatin LAR Depot and Sandostatin are indicated for the treatment of acromegaly who have had an inadequate response to surgery and/or radiotherapy, or for whom surgery and/or radiotherapy, is n..."