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Sandostatin LAR Depot 20 Mg Kit (octreotide,microspheres)
Hormones : Drugs for Growth
  • Step Therapy: Acromegaly:
    ST Single Generic

  • Prior Authorization: Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Acromegaly:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Endocrinologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)

    Neuroendocrine Tumor (NET):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)

    Oncology: Carcinoid Syndrome:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    Requires diagnosis of Carcinoid syndrome with diarrhea: Yes
    Concomitant Therapy Required with Somatostatin Analog Therapy: No
    Patient Required to Try Increased Dosage of Sandostatin: No

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