| Anthem Blue Cross (HMO, PPO, EPO) |
| SandoSTATIN (octreotide acetate) |
| Hormones : Drugs for Growth |
- Available only through Specialty Pharmacy;
- PA Applies
- Step Therapy: Oncology: Carcinoid Syndrome:
ST Multiple Generics
- Oncology: Carcinoid Syndrome:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Requires diagnosis of Carcinoid syndrome with diarrhea: No
Concomitant Therapy Required with Somatostatin Analog Therapy: No
Patient Required to Try Increased Dosage of Sandostatin: No
- Prior Authorization: Oncology: Carcinoid Syndrome:
Duration: 1 year(s)
|