Sandostatin — Cigna
Acromegaly in adults with inadequate response to or who cannot be treated with surgery, pituitary irradiation, and bromocriptine mesylate at maximally tolerated doses
Preferred products
- Octreotide acetate immediate-release injection
Initial criteria
- Patient meets the standard Somatostatin Analogs – Octreotide Immediate-Release Products Prior Authorization Policy criteria; AND
- Patient has tried generic octreotide acetate immediate-release injection
Approval duration
1 year