Mycapssa (octreotide delayed-release capsules – Amryt) — Cigna

Initial criteria

• Patient has (or had) a pretreatment (baseline) insulin-like growth factor 1 (IGF-1) level above the upper limit of normal based on age and gender for the reporting laboratory; AND
• According to the prescriber, patient has responded to one octreotide acetate injection product or Somatuline Depot (lanreotide injection); AND
• The medication is prescribed by or in consultation with an endocrinologist

Approval duration

1 year