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Sandostatin — Cigna

Acromegaly

Initial criteria

  • Patient meets ONE of the following (i, ii, or iii): i. Patient has had an inadequate response to surgery and/or radiotherapy; OR ii. Patient is NOT an appropriate candidate for surgery and/or radiotherapy; OR iii. Patient is experiencing negative effects due to tumor size (e.g., optic nerve compression)
  • Patient has (or had) a pre-treatment (baseline) insulin-like growth factor-1 (IGF-1) level above the upper limit of normal based on age and gender for the reporting laboratory
  • Medication is prescribed by or in consultation with an endocrinologist

Approval duration

1 year