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Somatuline Depot- Preferred Somatostatin Drug Therapy Effective August 1, 2022

Audience: Endocrinologists and Oncologists

Somatuline Depot- Preferred Somatostatin Drug Therapy Analog Effective August 1, 2022

We want to make you aware of a recent change regarding treatment with long-acting somatostatin analog drugs that applies to all lines of health care business.

Somatuline® Depot is now the preferred long-acting somatostatin analog drug for the treatment of acromegaly and neuroendocrine tumor conditions.

Starting August 1, 2022, the following changes will occur.  These changes impact new starts only and does not apply to existing users of the below mentioned medications:

Medical Benefit (administered by a healthcare provider)

All Lines of Business

No prior authorization required

Prior authorization required

Somatuline® Depot

 Lanreotide*

 Sandostatin® LAR

 Signifor® LAR*

Pharmacy Benefit (self-administered)

Formulary

Preferred Drug (no prior authorization required)

Prior authorization required

Non-formulary

Commercial Open

Somatuline® Depot

Lanreotide

MYCAPSSA®

Sandostatin® LAR

Commercial Closed Exchange

Child Health Plus

Medicaid Managed Care

Somatuline® Depot

Lanreotide

Mycapssa®

Sandostatin® LAR

Medicare Part D

Sandostatin® LAR

Somatuline® Depot

MYCAPSSA®*

Lanreotide

*Prior authorization is already required.

 

If submitting a prior authorization request for Sandostatin® LAR, Signifor® LAR, Lanreotide, or MYCAPSSA ®, please include all of the following relevant clinical information:

 

  • Diagnosis
  • Clinical justification as to why Somatuline® Depot is not the best choice for your patient
  • Rationale as to why you are requesting a step therapy protocol override is also required

This formulary and policy change was reviewed and approved by our Pharmacy & Therapeutics (P&T) Committee, which is comprised of local physicians and pharmacists who are not employed by our Health Plan. 

Billing Requirements

To ensure accurate prescribing and correct claim submissions, please follow the requirements outlined below and share this important information with your billing office/billing service and anyone within your practice who should be aware.

Billing Requirements

Somatuline® Depot can be provider-administered (billed under the member’s medical benefit) or
patient-administered (billed under the member’s pharmacy benefit)

J-code

NDC

J1930 Injection, lanreotide, (Somatuline® Depot), 1mg

Somatuline® Depot 60mg/0.2ml solution

  • 15054-1060-03
  • 15054-1060-04

Somatuline® Depot 90mg/0.3ml solution

  • 15054-1090-03
  • 15054-1090-04

Somatuline® Depot 120mg/0.5ml solution

  • 15054-1120-03
  • 15054-1120-04
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