CommercialPrior AuthMedium impact
Effective Oct. 1, 2024, Prior Authorization will be Required for Somatuline Depot Lanreotide Under the Commercial and ACA Medical Benefit
Medical Mutual of Ohio·Endocrinology, Oncology, Gastroenterology·Prior Authorization
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
Starting October 1, 2024, Medical Mutual requires prior authorization for Somatuline Depot (lanreotide) injections under commercial and ACA plans. Other lanreotide products will continue to be processed without prior authorization.
Action Required
By October 1, 2024: Billing team must update prior authorization requirements for HCPCS code J1930 (Somatuline Depot lanreotide) for Medical Mutual commercial and ACA plans only. Update billing system to flag J1930 for prior auth verification before administration. Verify other lanreotide codes (J3490, C9399, J1932) do not require prior auth and will process through claims edits.