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Sandostatin — Medica

any indication covered under the Somatostatin Analogs – Octreotide Immediate-Release Products Prior Authorization Policy

Preferred products

  • octreotide acetate immediate-release injection

Initial criteria

  • Patient meets the standard Somatostatin Analogs – Octreotide Immediate-Release Products Prior Authorization Policy criteria AND has tried at least one Preferred Product (octreotide acetate immediate-release injection)

Approval duration

as noted in standard Somatostatin Analogs – Octreotide Immediate-Release Products Prior Authorization Policy