Lanreotide (Somatuline Depot)
EVICORE-MEDICAL_DRUG-D15D335C
Covered: Somatuline Depot (lanreotide) for long‑term treatment of acromegaly (non‑oncology only) in patients who have inadequate response to or are not candidates for surgery/radiotherapy, or who have tumor‑related mass effects; oncology uses are excluded. Key requirements: baseline IGF‑1 > lab ULN, prescription or consultation by an endocrinologist, documentation of inadequate response/not candidate or tumor compression, adherence to dosing/monitoring (start 90 mg q4w ×3 months with GH/IGF‑1‑guided dose adjustments and optional 120 mg q6–8w extension with follow‑up labs), and approval limited to 12 months.
"Long-term treatment of acromegalic patients who have had an inadequate response to surgery and/or radiotherapy."
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