Signifor LAR (pasireotide) — Coverage Criteria
Clinical coverage criteria and coding guidance for Signifor LAR (pasireotide pamoate) when requested under the medical benefit; applies to clinicians and prior authorization reviewers evaluating use for acromegaly or Cushing's disease.
No material clinical or coverage changes in this revision.
Coverage Criteria
COVERAGE CRITERIA
Requests may be approved when ALL of the following match the applicable disease-specific branch:
Indication
- Acromegaly branch: I. Documentation is provided that individual has a diagnosis of acromegaly; AND II. Diagnosis of acromegaly has been verified by, or in consultation with, a board-certified endocrinologist who has reviewed and verified the test results (including but not limited to: Insulin-like Growth Factor 1 levels; Oral Glucose Tolerance Test with associated Growth Hormone (GH) levels) that are indicative of a positive test; AND III. Individual has had an inadequate response to surgery and/or surgery is not an option (including but not limited to, individual is an inappropriate candidate for surgical-based therapy).
- Cushing's disease branch: IV. Documentation is provided that individual has a diagnosis of Cushing's disease; AND V. Diagnosis of Cushing's has been verified by, or in consultation with, a board-certified endocrinologist who has reviewed and verified the test results (including but not limited to: 24-hour urinary free cortisol (UFC) test; Dexamethasone suppression test (DST); Late-night salivary cortisol (LNSC) test) that are indicative of a positive test; AND VI. One of the following: a. Disease persists or recurs following pituitary surgery; OR b. Pituitary surgery is not indicated or an option.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.