Sandostatin (octreotide acetate) — United Healthcare
Chemotherapy- and/or radiation-induced diarrhea
Initial criteria
- Diagnosis of diarrhea due to concurrent cancer chemotherapy and/or radiation
- AND
- Presence of Grade 3 or 4 severe diarrhea OR patient is in palliative or end-of-life care
Reauthorization criteria
- Documentation of positive clinical response to Sandostatin therapy
Approval duration
12 months