Somatostatin Analogs (CPB 0693, reviewed 2026-07-15)

By 2026-07-15, billing and clinical staff must implement the following: (1) Update billing system templates and prior authorization workflows to require precertification for octreotide acetate (Sandostatin, Sandostatin LAR Depot), lanreotide (Somatuline, generic), pasireotide diaspartate (Signifor), and pasireotide pamoate (Signifor LAR) before claim submission—all claims without precertification will be denied; (2) Integrate the specific medical necessity criteria into precertification forms for each drug indication (acromegaly requires IGF-1 lab values; Cushing's disease requires specific cortisol tests; NETs require appropriate imaging/pathology documentation); (3) For octreotide LAR Depot and lanreotide Depot infusions, verify site-of-service compliance with the Utilization Management Policy on Site of Care for Specialty Drug Infusions before authorizing; (4) Train providers that pasireotide diaspartate (Signifor) prescriptions must be from or in consultation with an endocrinologist or specialized prescriber—claims from non-qualified prescribers will be denied; (5) Establish continuation-of-therapy tracking: octreotide/lanreotide continuation requires documented clinical benefit or normalized IGF-1; pasireotide diaspartate continuation requires documented cortisol reduction or symptom improvement; (6) Contact Aetna precertification line (866) 752-7021 or fax (888) 267-3277 to request Statement of Medical Necessity forms; (7) Providers must document that non-preferred lower-cost alternatives within the same therapeutic class have been trialed or deemed clinically inappropriate before requesting higher-cost formulations. Failure to obtain precertification or meet medical necessity criteria will result in claim denials.