Somavert (pegvisomant subcutaneous injection − Pfizer) — Cigna

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); AND
• 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; AND
• Medication is prescribed by or in consultation with an endocrinologist

Approval duration

1 year