For an overview of coverage for Sandostatin® LAR Depot see:
For more detailed information about insurance coverage, see:
- Coverage of Initial Therapy with Immediate-Release Sandostatin® Injection
- Coverage of Long-term Therapy with Sandostatin® LAR Depot
- Appealing Denied Claims
Reimbursement for Sandostatin® LAR Depot depends on the insurer. For most patients, the cost of medical therapy is shared through copayments and insurance deductibles. To learn more about reimbursement for Sandostatin® LAR Depot, see:
Sandostatin® LAR Depot Coverage at a Glance
To understand your patient's coverage, you need to know that:
- Most private medical insurance plans will cover for immediate-release Sandostatin® Injection and Sandostatin® LAR Depot through a patient's pharmacy benefit
- Patients without a pharmacy benefit through their primary insurer should determine whether they have coverage for immediate-release Sandostatin® Injection through secondary insurance
- Generally, Medicaid does provide coverage for immediate-release Sandostatin® Injection
- Medicare does not provide coverage for self-administered injectable therapy
Coverage of Initial Therapy with Immediate-Release Sandostatin® Injection
Most private medical insurance plans will cover immediate-release Sandostatin® Injection through a patient's pharmacy benefit. Patients who do not have a pharmacy benefit through their primary insurer should determine whether they have coverage for immediate-release Sandostatin® Injection through secondary insurance. The Sandostatin® Support Hotline (1-877-LAR-HELP) can assist you in determining a patient's insurance coverage for immediate-release Sandostatin® Injection.
Medicare does not provide coverage for self-administered injectable therapy. To assist some of these patients, as well as to assist some patients who do not have a prescription drug benefit, Novartis Pharmaceuticals Corporation has set up the Sandostatin® Starter Program, a complimentary program that provides 2 to 4 weeks of immediate-release Sandostatin® Injection.
Coverage of Long-Term Therapy With Sandostatin® LAR Depot
Private insurers and Medicare generally cover medically necessary drugs provided in the physician's office and outpatient clinic settings. However, some plans may have special requirements as to how the drug should be purchased, or what kind of provider should inject it.
The Sandostatin® Support Hotline can provide information to help healthcare professionals determine plan-specific coverage, referrals, prior authorization, and reimbursement policies.
Appealing Denied Claims
Insurers may deny claims for a variety of reasons. Often, physicians can successfully appeal denied claims if the treatment is medically necessary. To help prevent inappropriately denied claims, it is suggested that the prescriber contact the patient's insurer to determine if letters of medical necessity and/or prior authorization are required before administering the product.
To appeal a denied claim, follow these steps:
Step 1. Carefully review the patient's explanation of benefits (EOB) from the insurer. Often claims are denied because of missing identification numbers, patient names, or signatures.
Step 2. If you have ruled out claims submission errors, you may need to support the claim by documenting medical necessity. Insurers may deny coverage if they are not familiar with Sandostatin® LAR Depot. Resubmit the claim with a letter of medical necessity that highlights the following:
- The patient's medical history
- Other therapies that have been tried
- The reason Sandostatin® LAR Depot was prescribed for this patient
- The risks of foregoing Sandostatin® LAR Depot treatment
- A Sandostatin® LAR Depot package insert (PDF 332KB)
- Peer-reviewed articles concerning the use of Sandostatin® LAR Depot
- An invoice
Step 3. Encourage patients to contact their benefits office regarding denied claims and talk to the benefits manager, if necessary. Remember that many efforts to pursue coverage and payment are successful, although the process may be lengthy.
INDICATIONS AND USAGE
Sandostatin® LAR Depot (octreotide acetate for injectable suspension) is indicated for patients in whom initial treatment with immediate release Sandostatin® (octreotide acetate) Injection has been shown to be effective and tolerated for:
- Long-term maintenance therapy in acromegalic patients who have had inadequate response to surgery and/or radiotherapy or for whom surgery and/or radiotherapy is not an option (the goal of treatment in acromegaly is to reduce GH and IGF-1 levels to normal).
- Long-term treatment of the severe diarrhea and flushing episodes associated with metastatic carcinoid tumors.
- Long-term treatment of the profuse watery diarrhea associated with VIP-secreting tumors.
In patients with carcinoid syndrome and VIPomas, the effect of Sandostatin Injection and Sandostatin LAR Depot on tumor size, rate of growth and development of metastases has not been determined.
IMPORTANT SAFETY INFORMATION
Warnings and Precautions:
- Gallbladder abnormalities may occur: Patients should be monitored periodically.
- Glucose Metabolism: Hypoglycemia or hyperglycemia may occur. Blood glucose levels should be monitored when Sandostatin LAR Depot treatment is initiated or when the dose is altered. Antidiabetic treatment should be adjusted accordingly.
- Thyroid Function: Hypothyroidism may occur. Baseline and periodic assessment of thyroid function (TSH, total and/or free T4) is recommended.
- Cardiac Function: Bradycardia, arrhythmia, conduction abnormalities, and other EKG changes may occur. The relationship of these events to octreotide acetate is not established because many of these patients have underlying cardiac disease. Use with caution in at-risk patients.
- Nutrition: Octreotide may alter absorption of dietary fats. Monitoring of vitamin B12 levels is recommended during therapy with Sandostatin LAR Depot. Patients on total parenteral nutrition (TPN) and octreotide should have periodic monitoring of zinc levels.
Drug Interactions: The following drugs require monitoring and possible dose adjustment when used with Sandostatin LAR Depot: cyclosporine, insulin, oral hypoglycemic agents, beta-blockers, bromocriptine. Octreotide has been associated with alterations in nutrient absorption, so it may have an effect on absorption of orally administered drugs. Drugs mainly metabolized by CYP3A4 and which have a low therapeutic index should be used with caution.
Adverse Reactions: The most common adverse reactions occurring in patients receiving Sandostatin LAR Depot are:
- Acromegaly: biliary abnormalities (52%), diarrhea (36-48%), cholelithiasis (13-38%), abdominal pain or discomfort (11-29%), flatulence (26%), influenza-like symptoms (20%), constipation (19%), headache (15%), anemia (15%), hyperglycemia (15%), injection site pain (2-14%), hypertension (13%), dizziness (12%), fatigue (11%), nausea (10%), vomiting (7%), hypothyroidism (2%), hypoglycemia (2%), and goiter (2%).
- Carcinoid Tumors and VIPomas: biliary abnormalities (62%), injection site pain (20-50%), nausea (24-41%), abdominal pain (10-35%), fatigue (8-32%), headache (16-30%), hyperglycemia (27%), back pain (8-27%), constipation or vomiting (15-21%), dizziness (18-20%), sinus bradycardia (19%), pruritus (18%), URTI (10-18%), myalgia (4-18%), flatulence (9-16%), arthropathy (8-15%), rash (15%), generalized pain (4-15%), sinusitis (5-12%), conduction abnormalities (9%), hypoglycemia (4%), and arrhythmia (3%).
