Somatostatin Analogs - Lanreotide Products (coverage)
Defines medical necessity, dosing limits, and prior authorization requirements for lanreotide products (including Somatuline Depot and Cipla lanreotide) across Cigna-administered health benefit plans. Applies to providers submitting coverage requests for these medications.
Criteria for oncology indications (Carcinoid syndrome and gastroenteropancreatic neuroendocrine tumors) were added.
Acromegaly criteria were revised: removed GH suppression testing option and clarified preferred product step-through; added dosing.
Added criteria for pheochromocytoma and paraganglioma as other uses with supportive evidence.
Specified step-through requirement for Cipla lanreotide requiring prior trial of Somatuline Depot or lanreotide acetate except when inactive ingredient allergy/serious reaction is present.
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