Somatuline Depot (lanreotide acetate) prior authorization / patient information
This document is a Cigna patient information and prior authorization form for Somatuline Depot (lanreotide acetate) used to request coverage and provide clinical justification; it applies to providers submitting requests for affected patients and to the handling of specialty pharmacy dispensing and site-of-care details.
No material clinical or coverage changes in this revision.
Coverage criteria for Somatuline Depot (lanreotide acetate)
Diagnosis-specific medical necessity checkpoints
Coverage consideration guided by diagnosis-specific documentation; provider must confirm ALL applicable items for the chosen diagnosis.
Pre-treatment (baseline) IGF-1 must be prior to initiation of any somatostatin analog, dopamine agonist, or pegvisomant.
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