Octreotide Acetate for Injectable Suspension (Sandostatin LAR Depot)
National · Effective Jul 18, 2024
1 active Medicare policy lists J2354, and 35 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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National · Effective Jul 18, 2024
35 policies from 20 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of J2354 |
|---|---|---|
| Octreotide acetate injection (Sandostatin LAR Depot, Sandostatin)Effective 01/01/2019 - 08/31/2019 | Jan 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Octreotide acetate injection (Sandostatin LAR Depot, Sandostatin)Effective 08/01/2020 - 06/30/2021 | Aug 1, 2020 | Prior auth requiredInferred from policy title |
| Octreotide acetate injection (Sandostatin LAR Depot, Sandostatin)Effective 09/01/2019 - 07/31/2020 | Sep 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Octreotide Acetate Long-acting Products (Sandostatin LAR Depot, generic) - non-oncology | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Octreotide Acetate Long-acting Products (Sandostatin LAR Depot, generic)Effective 05/01/2025 - 04/30/2026 | May 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Octreotide Products (Sandostatin, Sandostatin LAR)Effective 06/01/2022 - 05/31/2023 | Jun 1, 2022 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Octreotide Products (Sandostatin, Sandostatin LAR)Effective 06/01/2023 - 04/30/2024 | Jun 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Octreotide Products (Sandostatin, Sandostatin LAR)Effective 07/01/2021 - 05/31/2022 | Jul 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Sandostatin LAR Depot (octreotide acetate) for Injectable Suspension and Sandostatin (octreotide acetate) InjectionEffective 03/01/2025 - 04/30/2025 | May 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J2354 |
|---|---|---|
| Octreotide Acetate (Sandostatin LAR Depot) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Octreotide Acetate (Sandostatin LAR Depot) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Octreotide Acetate (Sandostatin LAR Depot) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Octreotide Acetate (Sandostatin LAR Depot) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Octreotide Acetate (Sandostatin LAR Depot) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Octreotide | Oct 15, 2024 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Octreotide | Oct 15, 2024 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Octreotide | Oct 15, 2024 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Octreotide | Oct 15, 2024 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Somatostatin Analogs | Jul 1, 2023 | Covered |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Octreotide Acetate (e.g., Sandostatin) for Injectable Suspension (e.g., Sandostatin LAR Depot) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Octreotide acetate | May 1, 2026 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Octreotide Suspension (Sandostatin LAR Depot), Octreotide Acetate for Injectable Suspension | Dec 1, 2016 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Octreotide Acetate (Sandostatin, Sandostatin LAR, Mycapssa); CP.PHAR.40 | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Somatostatin analogues for acromegaly (Sandostatin LAR, Somatuline Depot, Signifor LAR, Somavert, Lanreotide) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Sandostatin, Sandostatin LAR depot (Octreotide), Somatuline Depo (lanreotide), Signifor LAR (pasireotide) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Sandostatin LAR (octreotide suspension) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Somatostatin Analogs | Apr 1, 2026 | Covered |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Somatostatin Analogs | Apr 1, 2026 | Covered |
| Policy | Effective | Status of J2354 |
|---|---|---|
| Somatostatin Analogs | Apr 1, 2026 | Covered |