Medicare AdvantagePrior AuthMedium impact
Sandostatin® S.C., Sandostatin LAR® Depot (octreotide acetate for injection) (Revised)
Humana·KY, SC · Endocrinology, Gastroenterology, Oncology +1 more·Medicaid
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana has revised its prior authorization policy for Sandostatin and Sandostatin LAR (octreotide acetate injections) used to treat acromegaly, carcinoid tumors, VIPomas, and severe diarrhea conditions. The policy requires prior authorization for brand Sandostatin subcutaneous with specific clinical criteria that must be met for each indication, though previous treatment requirements don't apply to Medicare Part B requests.
Action Required
Immediately: Billing team must verify prior authorization is obtained before administering Sandostatin or Sandostatin LAR for acromegaly, carcinoid tumors, VIPomas, chemotherapy/radiation-induced diarrhea, AIDS-related diarrhea, or carcinoid crisis. Update prior auth checklist to include specific clinical criteria documentation for each indication. Note that Medicare Part B requests are exempt from previous treatment requirements. Claims without proper prior authorization will be denied.