Audience: Endocrinologists and Oncologists
Somatuline Depot- Preferred Somatostatin Drug Therapy Analog Effective August 1, 2022
We want to make you aware of a recent change regarding treatment with long-acting somatostatin analog drugs that applies to all lines of health care business.
Somatuline® Depot is now the preferred long-acting somatostatin analog drug for the treatment of acromegaly and neuroendocrine tumor conditions.
Starting August 1, 2022, the following changes will occur. These changes impact new starts only and does not apply to existing users of the below mentioned medications:
Medical Benefit (administered by a healthcare provider) |
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All Lines of Business |
No prior authorization required |
Prior authorization required |
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Somatuline® Depot |
Lanreotide* Sandostatin® LAR Signifor® LAR* |
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Pharmacy Benefit (self-administered) |
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Formulary |
Preferred Drug (no prior authorization required) |
Prior authorization required |
Non-formulary |
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Commercial Open |
Somatuline® Depot |
Lanreotide MYCAPSSA® Sandostatin® LAR |
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Commercial Closed Exchange Child Health Plus Medicaid Managed Care |
Somatuline® Depot |
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Lanreotide Mycapssa® Sandostatin® LAR |
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Medicare Part D |
Sandostatin® LAR Somatuline® Depot |
MYCAPSSA®* |
Lanreotide |
*Prior authorization is already required.
If submitting a prior authorization request for Sandostatin® LAR, Signifor® LAR, Lanreotide, or MYCAPSSA ®, please include all of the following relevant clinical information:
- Diagnosis
- Clinical justification as to why Somatuline® Depot is not the best choice for your patient
- Rationale as to why you are requesting a step therapy protocol override is also required
This formulary and policy change was reviewed and approved by our Pharmacy & Therapeutics (P&T) Committee, which is comprised of local physicians and pharmacists who are not employed by our Health Plan.
Billing Requirements
To ensure accurate prescribing and correct claim submissions, please follow the requirements outlined below and share this important information with your billing office/billing service and anyone within your practice who should be aware.
Billing Requirements |
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Somatuline® Depot can be provider-administered (billed under the member’s medical benefit) or |
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J-code |
NDC |
J1930 Injection, lanreotide, (Somatuline® Depot), 1mg |
Somatuline® Depot 60mg/0.2ml solution
Somatuline® Depot 90mg/0.3ml solution
Somatuline® Depot 120mg/0.5ml solution
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