Sandostatin — Cigna
Profuse watery diarrhea associated with vasoactive intestinal peptide (VIP)-secreting tumors in adults
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