CommercialPrior AuthMedium impact
Octreotide Products (Revised)
Humana·Endocrinology, Oncology, Gastroenterology·Commercial
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana revised their octreotide products prior authorization policy for commercial plans, requiring prior treatment or intolerance with generic subcutaneous octreotide before approving brand Sandostatin for acromegaly, carcinoid tumors, and VIPomas. The policy maintains specific diagnosis and symptom criteria for each condition.
Action Required
Immediately: Billing team must ensure prior authorization requests for octreotide products (Sandostatin injection, octreotide acetate injection) include documentation of previous treatment or intolerance with generic subcutaneous octreotide, plus specific diagnosis criteria and symptoms for acromegaly, carcinoid tumors, or VIPomas. Update prior auth checklists to include these requirements. Claims without proper prior authorization will be denied.