Lanreotide (Somatuline Depot) (PDF)
Defines medical necessity criteria, step therapy/redirection, dosing limits, approval durations, continued therapy requirements, exclusions, coding implications, and state-specific step-therapy exceptions for Somatuline Depot and unbranded lanreotide across Commercial, HIM, and Medicaid lines of business.
Added confirmatory diagnostic requirements for acromegaly (IGF-I or GH) and clarified NET criteria including DIPNECH and SSTR requirements; updated HCPCS codes (removed C9399, added J3490).
Added redirection to octreotide acetate LAR and to Sandostatin LAR Depot if generic unavailable, and requirement to use generic lanreotide for Somatuline Depot requests when available.
Added Appendix E states and step therapy bypass details; added Mississippi and Indiana to Appendix E over time and applied IL HIM bypass per IL HB 5395 effective 1/1/2026.
Revised GH threshold wording from 'µg/mL' to 'µg/L' per PS/ES guidelines and ACG.
Added unbranded lanreotide formulation and newly approved carcinoid syndrome indication to FDA Approved Indication(s).
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.