Somatostatin Analogs – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers somatostatin analogs for acromegaly (when surgery/radiation/dopaminergic therapy are inadequate or not options), symptomatic carcinoid syndrome, VIPoma‑associated diarrhea, bleeding gastroesophageal varices, chemotherapy/radiation‑induced diarrhea, malignant bowel obstruction, and Cushing’s disease when surgery is not an option or not curative, but lists uses such as HIV‑related diarrhea, chylothorax, dumping syndrome, pancreatitis prophylaxis, persistent hyperinsulinemic hypoglycemia of infancy, short bowel syndrome and other non‑evidence‑based indications as unproven/not medically necessary. Coverage requires documentation of indication‑specific findings and prior therapies (e.g., evidence of inadequate response or contraindication to surgery/radiation/dopamine agonists for acromegaly, and a prior effective/tolerated trial of short‑acting octreotide before Sandostatin LAR), physician‑supervised IM administration for LAR products, use of specified HCPCS/ICD‑10 codes, and verification of member‑specific benefits.