CommercialPrior AuthMedium impact
Pasireotide (Signifor® LAR)
BCBS Tennessee·TN · Endocrinology, Internal Medicine·Medical Policy
Effective date
Dec 1, 2026
We identified it
Sep 10, 2026
Summary
BlueCross BlueShield of Tennessee has issued a new medical policy for Pasireotide (Signifor® LAR) effective December 1, 2026, establishing coverage criteria for acromegaly and Cushing's disease treatment. The policy requires step therapy, specific laboratory documentation for initial and continuation approvals, and limits authorization to 12-month periods. All prior authorization requests must include documented evidence of inadequate surgical response or surgical ineligibility, plus baseline hormone level testing.
Action Required
By November 15, 2026: Billing and prior authorization teams must review the BlueCross BlueShield of Tennessee Pasireotide policy and update internal PA protocols accordingly. Providers must be notified to: (1) submit high pretreatment IGF-1 levels or confirmed cortisol testing results for acromegaly and Cushing's disease cases respectively, (2) document surgical history (inadequate response or surgical ineligibility), and (3) include continuation labs showing normalized/decreased hormone levels for 12-month reauthorization requests. Update EMR templates and PA request forms to capture required documentation fields. Reference the Step Therapy Guide at https://www.bcbst.com/docs/providers/Comm_BC_PAD_Step_Therapy_Guide.pdf for specialty medication submission requirements. Failure to obtain prior authorization or submit required documentation will result in claim denials for this specialty medication.