Useful Forms
Download forms to:
- Complete an application form to enroll a patient in the Sandostatin® Starter Program (PDF 194KB)
- Easy Access Program Service Request Form (PDF 100KB) to order Sandostatin LAR® Depot (octreotide acetate for injectable suspension)
- Form CMS-1500 (PDF 361KB) to request reimbursement for Sandostatin LAR® Depot (octreotide acetate for injectable suspension) in a private office setting
- Form CMS-1450 (formerly known as form UB-92) (PDF 136KB) to request reimbursement for Sandostatin LAR® Depot in a hospital outpatient setting
Letters of Medical Necessity
Download sample letters of medical necessity or prior authorization. These samples are provided solely for informational purposes, and Novartis makes no guarantee as to the outcome of any particular claim.
Claim denials are often reversed when a physician submits a letter of medical necessity. For your convenience, these sample letters are formatted in Microsoft® Word.* Download sample letters of medical necessity for:
- Acromegaly (25KB)
- Carcinoid syndrome (27KB)
- VIPomas (23KB)
You may also download a sample letter of prior authorization (22KB).
*Microsoft is either a registered trademark or trademark of Microsoft Corporation in the United States and/or other countries.
