CommercialPrior AuthMedium impact
08.01.10l, Octreotide Acetate (Sandostatin® LAR Depot)
Independence Blue Cross·Endocrinology, Gastroenterology, Oncology +1 more·Pharmacy
Effective date
Jun 29, 2026
We identified it
Jun 30, 2026
Summary
Medical necessity criteria for Octreotide Acetate (Sandostatin® LAR Depot) have been updated effective 06/29/2026. This is a pharmacy policy change for a commercial plan that establishes or modifies the medical necessity requirements for this injectable medication. The billing team must review updated criteria to ensure claims meet new documentation and approval standards.
Action Required
By 06/29/2026: Billing and clinical teams must obtain and review the complete updated medical necessity criteria for Octreotide Acetate (Sandostatin® LAR Depot) from the policy URL. Update billing system logic and prior authorization templates to reflect new criteria. Coordinate with providers to ensure all claims include documentation supporting medical necessity per the revised policy. All claims submitted on or after the effective date must comply with new criteria or face denial. Contact the payer (IBX) immediately if criteria details are unclear.