Mycapssa (octreotide) — Point32Health

Initial criteria

• Documented diagnosis of acromegaly
• The prescribing physician is an endocrinologist
• Documentation the patient has had a failure of or is unable to tolerate a treatment regimen that included generic injectable octreotide or lanreotide
• Documentation the patient is not a candidate for surgery and/or radiation, or has had an inadequate response to surgery and/or radiation

Reauthorization criteria

• Documented diagnosis of acromegaly
• The prescribing physician is an endocrinologist
• Documentation of a reduction in baseline growth hormone and/or insulin-like growth factor serum concentrations

Approval duration

initial 6 months; reauth 12 months