Octreotide

This policy covers octreotide products (e.g., Sandostatin and Sandostatin LAR Depot) for FDA‑approved indications and select off‑label uses supported by recognized compendia or at least two peer‑reviewed articles, including treatment and maintenance of acromegaly and symptomatic control of carcinoid syndrome and VIP‑producing tumors. Coverage is limited to FDA‑approved, formulary drugs with dosing/frequency consistent with authoritative sources, requires intramuscular administration of Sandostatin LAR by a trained provider, excludes oncology indications, and is subject to member benefit plan/contract and state‑specific rules (applies to HCSC members in Ohio).

"Coverage of any FDA‑approved drug when prescribed for a use recognized as safe and effective in one or more standard medical reference compendia adopted by the U."

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