By Counterforce Health Team in Signifor / Signifor LAR (pasireotide) — 26 Sep 2025

How to Get Signifor LAR (Pasireotide) Covered by Aetna in Michigan: Prior Authorization Forms and Appeal Guide

Answer Box: Getting Signifor LAR Covered by Aetna in Michigan

Aetna requires prior authorization for Signifor LAR (pasireotide) in Michigan. You must document trial and failure of Somatuline Depot (lanreotide) first, plus provide biochemical evidence (elevated UFC for Cushing's disease or IGF-1 for acromegaly). Submit via CVS Specialty Pharmacy with complete clinical documentation. If denied, you have 127 days to file an external review with Michigan DIFS. Start today: Download Aetna's Signifor LAR prior authorization form and gather your lab results.

What This Guide Covers
Before You Start: Verify Your Coverage
Gather What You Need
Submit the Prior Authorization Request
Follow-Up and Timelines
Common Denial Reasons and How to Fix Them
If You're Denied: Appeals in Michigan
Renewal and Re-Authorization
FAQ
Quick Reference Checklist

What This Guide Covers

This guide helps Michigan patients and their healthcare providers navigate Aetna's prior authorization process for Signifor LAR (pasireotide), a specialty medication used to treat Cushing's disease and acromegaly. We'll walk you through the exact forms, documentation requirements, and timelines—plus what to do if you're denied.

Who this helps:

Patients with Cushing's disease or acromegaly prescribed Signifor LAR
Healthcare providers submitting prior authorizations to Aetna
Families navigating specialty drug coverage in Michigan

Counterforce Health specializes in turning insurance denials into successful appeals by creating evidence-backed, policy-specific rebuttals. Their platform helps patients, clinicians, and pharmacies streamline the prior authorization process and improve approval rates for complex specialty medications like Signifor LAR.

Before You Start: Verify Your Coverage

Check Your Plan Type

Aetna administers different types of plans with varying requirements:

Commercial plans: Standard prior authorization process
Medicare Advantage: May have additional CMS requirements
Medicaid managed care: Different forms and timelines

Action step: Look at your member ID card. Call the number on the back to confirm which prior authorization form applies to your specific plan.

Confirm Pharmacy Benefits

Signifor LAR is dispensed exclusively through CVS Specialty Pharmacy (part of CVS Caremark) for most Aetna plans. Standard retail pharmacies cannot fill this prescription.

Coverage at a Glance

Requirement	Details	Where to Find It
Prior Authorization	Required for all plans	Aetna Precertification List
Formulary Tier	Specialty tier (highest copay)	Member portal or formulary document
Step Therapy	Must try Somatuline Depot first	Prior authorization form
Specialty Pharmacy	CVS Specialty only	CVS Specialty FAQ
Quantity Limits	Per FDA labeling	Varies by indication

Gather What You Need

Clinical Documentation Required

For Cushing's Disease:

Elevated 24-hour urinary free cortisol (UFC) levels
Failed dexamethasone suppression test results
Pituitary MRI showing adenoma (if available)
Documentation of surgical failure or inoperability

For Acromegaly:

Elevated age-adjusted IGF-1 levels
Growth hormone levels and/or oral glucose tolerance test results
Evidence of inadequate response to surgery and/or first-generation somatostatin analogs

Step Therapy Documentation

Aetna requires documentation of trial and failure or intolerance of Somatuline Depot (lanreotide) before approving Signifor LAR. You'll need:

Drug name, dose, and duration of treatment
Specific reason for discontinuation (lack of efficacy or adverse effects)
Lab results showing inadequate biochemical control
Clinical notes documenting symptoms or progression

Tip: About 25% of patients who don't respond to octreotide may respond to lanreotide, so your doctor may need to document trials of both first-generation analogs.

Required Forms and Information

Primary form: Aetna Signifor LAR Prior Authorization Request
Patient information: Full name, date of birth, member ID, contact information
Prescriber information: NPI number, specialty, contact details
ICD-10 codes: E24.0 (Cushing's disease) or E22.0 (acromegaly)
Requested therapy: Dosing, frequency, duration

Submit the Prior Authorization Request

Step-by-Step Submission Process

Complete the form: Use Aetna's current 2024 prior authorization form for Signifor LAR
Attach supporting documents: Lab results, imaging, clinical notes, step therapy documentation
Submit via preferred method:
- Electronic: Through Availity portal (fastest processing)
- Fax: Use the number provided on the specific form (varies by plan type)
- Phone: Call the number on the patient's member ID card for urgent cases
Confirm receipt: Get a reference number and expected processing timeframe
Route to CVS Specialty: Ensure the approved prescription goes to CVS Specialty Pharmacy

Note: Processing times are typically 30-45 days for standard requests, but urgent cases may be expedited to 72 hours with proper clinical justification.

Clean Request Packet Checklist

✓ Completed prior authorization form with all required fields
✓ Current lab results (UFC, IGF-1, or other relevant biomarkers)
✓ Documentation of first-generation SSA trial and failure
✓ Specialist consultation notes or referral
✓ Imaging results (pituitary MRI if available)
✓ Patient's current medication list and medical history

Follow-Up and Timelines

When to Call

Day 7: Confirm receipt if you haven't received acknowledgment
Day 21: Check status if no decision has been communicated
Day 35: Escalate if approaching the 45-day limit

Sample Call Script

"Hi, I'm calling to check the status of a prior authorization for Signifor LAR for [patient name], member ID [number]. The reference number is [reference number]. Can you tell me the current status and expected decision date?"

Document everything: Note the date, time, representative name, and any information provided.

Michigan-Specific Timelines

Commercial Plans: Aetna must respond within 30-45 days for standard requests Expedited Reviews: 72 hours when clinical urgency is documented Appeals: You have 180 days to file an internal appeal with Aetna after denial

Common Denial Reasons and How to Fix Them

Denial Reason	How to Overturn
"No trial of preferred agent"	Submit documentation of Somatuline Depot trial and failure/intolerance
"Insufficient biochemical evidence"	Provide current UFC (Cushing's) or IGF-1 (acromegaly) lab results with reference ranges
"Not prescribed by specialist"	Include endocrinologist consultation notes or transfer care to specialist
"Experimental/investigational"	Cite FDA approval and include prescribing information
"Quantity exceeds policy limits"	Provide clinical justification for dosing per FDA labeling

Medical Necessity Letter Essentials

When appealing, include a comprehensive medical necessity letter covering:

Problem statement: Specific diagnosis with ICD-10 codes
Prior treatments: Detailed history of failed therapies with dates, doses, and outcomes
Clinical rationale: Why Signifor LAR is medically necessary for this patient
Guideline support: References to FDA labeling and endocrine society guidelines
Monitoring plan: How the patient will be followed for safety and efficacy

If You're Denied: Appeals in Michigan

Internal Appeal with Aetna

Timeline: File within 180 days of denial notice Process: Submit appeal letter with additional supporting documentation Decision timeframe: 30 days for standard appeals, 72 hours for expedited

External Review with Michigan DIFS

If Aetna upholds the denial, Michigan residents can request an external review through the Department of Insurance and Financial Services (DIFS).

Key Facts:

Filing deadline: 127 days from Aetna's final denial
Standard review: Decision within 60 days
Expedited review: 72 hours with physician attestation of urgency
Binding decision: The Independent Review Organization's decision is final

How to file: Complete the DIFS External Review Request form online or by mail/fax.

Contact: Call DIFS at 877-999-6442 for assistance with the external review process.

From our advocates: We've seen many Signifor LAR denials overturned at the external review level when patients provide comprehensive biochemical documentation and clear evidence of first-generation SSA failure. The key is presenting a complete clinical picture that aligns with FDA labeling and specialty guidelines.

Renewal and Re-Authorization

Signifor LAR typically requires re-authorization every 6-12 months. Calendar reminders are essential—start the renewal process 30-60 days before your current authorization expires.

Renewal Documentation

Updated lab results: Recent UFC, IGF-1, or other relevant biomarkers
Clinical response: Documentation of improvement or disease control
Continued medical necessity: Ongoing need for treatment
Safety monitoring: Any adverse events or dose adjustments

FAQ

Q: How long does Aetna prior authorization take for Signifor LAR in Michigan? A: Standard requests take 30-45 days. Expedited reviews with clinical urgency documentation are completed within 72 hours.

Q: What if Signifor LAR is non-formulary on my plan? A: You can request a formulary exception by documenting medical necessity and failure of preferred alternatives. The process is similar to prior authorization.

Q: Can I request an expedited appeal if I'm denied? A: Yes, if waiting for a standard appeal could jeopardize your health. Your doctor must provide written certification of clinical urgency.

Q: Does step therapy apply if I failed SSAs outside Michigan? A: Yes, documentation of prior SSA failure from any location should satisfy Aetna's step therapy requirements, provided you have adequate records.

Q: What's the cost of Signifor LAR with Aetna coverage? A: Costs vary by plan. As a specialty tier medication, expect higher copays or coinsurance. Check with CVS Specialty for your specific out-of-pocket costs.

Q: Can my doctor handle the prior authorization for me? A: Yes, healthcare providers typically submit prior authorizations on behalf of patients. You can also authorize someone to appeal on your behalf.

Quick Reference Checklist

Before submitting:

✓ Verify plan type and specialty pharmacy requirements
✓ Download current Aetna Signifor LAR PA form
✓ Gather biochemical evidence (UFC or IGF-1 results)
✓ Document first-generation SSA trial and failure
✓ Include specialist consultation notes

After submission:

✓ Get reference number and expected timeline
✓ Follow up at 7, 21, and 35 days
✓ Document all communications
✓ Prepare appeal materials if needed

If denied:

✓ File internal appeal within 180 days
✓ Consider peer-to-peer review
✓ Request external review with Michigan DIFS within 127 days
✓ Gather additional supporting evidence

For renewals:

✓ Start process 30-60 days before expiration
✓ Update lab results and clinical response data
✓ Document continued medical necessity

Disclaimer: This guide provides general information about insurance coverage and is not medical advice. Coverage decisions depend on individual circumstances and plan terms. Always consult with your healthcare provider and insurance plan for specific guidance. For questions about Michigan insurance regulations, contact the Michigan Department of Insurance and Financial Services at 877-999-6442.

About Coverage Appeals: Counterforce Health helps patients, clinicians, and specialty pharmacies turn insurance denials into targeted, evidence-backed appeals. Their platform analyzes denial letters and plan policies to create point-by-point rebuttals that align with payer-specific requirements, improving approval rates for complex specialty medications.

Sources & Further Reading

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