Signifor® LAR (pasireotide) Injectable Suspension

Signifor LAR is covered for FDA‑approved acromegaly and Cushing’s disease and for compendial off‑label endogenous Cushing’s syndrome, and is excluded when the policy’s diagnostic, prior‑treatment, lab, prescriber‑specialty, dosing or documentation criteria are not met. Coverage requires documented inadequate response to or ineligibility for surgery (or tumor mass effects), baseline and follow‑up labs (IGF‑1 for acromegaly; 24‑hour urinary free cortisol for Cushing’s with objective response required for reauthorization), prescription by or consultation with an endocrinologist/specialist, adherence to specified starting doses and step‑up timing (acromegaly 40 mg q4w → max 60 mg after 3 months if IGF‑1/GH not normalized; Cushing’s 10 mg q4w → max 40 mg after 4 months if UFC not normalized), and specified approval durations (initial Cushing’s 4 months; others 12 months).

"Acromegaly — treatment of patients with acromegaly who have had an inadequate response to surgery and/or whom surgery is not an option (FDA-approved indication)."