Pasireotide (Signifor®)


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


Initial authorization: One year


Last review date: July 21, 2016

The site you are transferring to is not hosted by WHA. WHA's Terms of Use and internet Privacy Practices do not apply to your use of this linked site. Please review the policies on privacy and terms of use for the linked site. WHA does not control the accuracy, completeness, or timeliness of the content on the linked site.

Press Esc to cancel

El sitio Web al que está siendo transferido no es provisto por WHA. Las Condiciones de Uso y las Prácticas de Privacidad en Internet de WHA no se aplican a este sitio Web asociado que usted está usando. Revise las políticas sobre la privacidad y condiciones de uso de este sitio Web asociado. WHA no tiene control sobre la exactitud, la totalidad o la actualidad del contenido del sitio Web asociado. WHA no puede garantizar que los servicios de traducción de idiomas estarán disponibles en el sitio vinculado.

Presione «Esc» para cancelar