Pasireotide (Signifor®)

Self administered

Indications for Prior Authorization

  • Adult Cushing’s disease
  • Acromegaly (FDA approved Signifor LAR:  12/17/2014)

All of the following must be met as a condition for coverage

  • Pituitary surgery is not an option or has not been curative

This Medication is Not Approvable for the following condition(s):

Any condition not listed above as an approved indication.


  • Cushing's disease:  Recommended dose: 0.3 to 0.9 mg twice a day.
  • Acromegaly:  Signifor LAR - Up to 40mg IM every 4 weeks for 3 months.
    • Dosing titration:  May increase to 60 mg IM every 28 days in patients who have not normalized growth hormone (GH) and/or insulin-like growth factor 1 (IGF-1) levels after 3 months.

Duration of Therapy

Initial authorization: one year

Western Health Advantage Pharmacy and Therapeutics Committee

Approved:  May 2013

Last review date: July 21, 2016