Mycapssa (octreotide) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of acromegaly (ICD-10: E22.0)
• high pretreatment insulin-like growth factor (IGF-1) based on laboratory reference range
• previously responded to and tolerated treatment with one of the following: octreotide OR lanreotide

Reauthorization criteria

• Decreased IGF-1 from baseline OR Normalized IGF-1 from baseline

Approval duration

12 months