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Does Medicare Cover Sandostatin?

Does Medicare Cover Sandostatin?

Tumors can cause many dangerous health effects if left unchecked and untreated. Sandostatin is a medication used to treat symptoms of certain types of tumors, such as gastrinoma.

So a common question many people have is, “does Medicare cover Sandostatin?” In this article, we answer that question in clear, plain English. You will also find the average costs of Sandostatin and other helpful info.

Does Medicare Cover Sandostatin?

The short answer is yes; Medicare will cover the cost of Sandostatin. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your Sandostatin. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for Sandostatin. But, in order to get coverage for your Sandostatin, it must be considered medically necessary. Your healthcare provider must first order the treatment for this insurance to provide coverage.

However, there is not much information about how this insurance plan provides coverage for the medication Sandostatin.

Original Medicare also provides coverage for the generic version of this medication known as octreotide acetate. 

Coverage for the administration of octreotide acetate is provided by Medicare Part B. Medicare Part B covers the administration of octreotide acetate in an outpatient setting.

Part B also provides coverage for administering the drug in a hospital rather than Medicare Part A. 

Part C and Part D Coverage for Sandostatin

Medicare Advantage plans (Medicare Part C) also provide coverage for Sandostatin. They cover everything Original Medicare covers, as well as some additional benefits. Exactly what it covers and the out-of-pocket costs vary depending on your plan’s specifics.

Medicare Part C plans that include prescription drug plans will also provide coverage for medications your healthcare provider will prescribe to you.

Medicare Part D plans provide coverage for Sandostatin. Part D is a prescription drug plan. Like Part C, Part D plans are provided by private insurance companies.

How Much Does Sandostatin Cost?

The average cost of 90 vials (1ml) of octreotide 100mcg/ml is $1,300. This varies depending on the pharmacy.

What Is Sandostatin Used For?

The medication Sandostatin can treat flushing and watery diarrhea caused by certain types of cancer, such as VIPomas and metastatic carcinoid tumors. Although it does not cure cancer, it provides relief to patients. 

Doctors use Sandostatin to treat acromegaly, a condition caused by too much growth hormone in the body.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series, including: Does Medicare cover Prolapse Surgery?

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Medicare Plan Tips Team

Annie Kaye is a writer and researcher who was thrown into the Medicare world while taking care of her ailing mother. Even with a degree in Library Science and a long history of fighting for what's right, she felt lost. She learned a lot about Medicare during that time and now writes to help others understand how the system works.