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Crenessity (crinecerfont) capsules 25 mg, 50 mg, 100 mg — Blue Cross Blue Shield of Alabama

classic congenital adrenal hyperplasia (CAH) due to 21‑hydroxylase deficiency

Initial criteria

  • ONE of the following:
  • • The patient is eligible for continuation of therapy AND ONE of the following:
  •  – has been treated with the requested agent (not initiated on samples) within the past 90 days OR
  •  – prescriber states patient has been treated with the requested agent (not started on samples) within the past 90 days and is at risk if therapy is changed
  • OR
  • BOTH of the following:
  • • Diagnosis of classic congenital adrenal hyperplasia (CAH) due to 21‑hydroxylase deficiency confirmed by ONE of:
  •  – positive infant screening with tier 2 confirmatory testing OR
  •  – elevated serum 17‑hydroxyprogesterone above upper limit of normal OR
  •  – cosyntropin (ACTH) stimulation test OR
  •  – genetic testing showing mutation in CYP21A2 gene consistent with CAH
  • AND
  • • If the patient has an FDA‑labeled indication, then ONE of:
  •  – patient's age is within FDA labeling for the requested indication OR
  •  – there is support for use of the requested agent for the patient’s age for the requested indication
  • AND
  • • Patient is currently treated with glucocorticoid replacement therapy (e.g., hydrocortisone, prednisone, prednisolone, dexamethasone)
  • • Patient will continue glucocorticoid replacement therapy in combination with the requested agent
  • • Prescriber is a specialist in endocrinology or genetics, or has consulted with such specialist
  • • Patient has no FDA‑labeled contraindications to the requested agent

Reauthorization criteria

  • • Patient previously approved through the plan’s prior authorization process
  • • Patient has demonstrated clinical benefit with the requested agent
  • • Patient currently treated with glucocorticoid replacement therapy
  • • Patient will continue glucocorticoid replacement therapy in combination with the requested agent
  • • Prescriber is a specialist in endocrinology or genetics, or has consulted with such specialist
  • • Patient has no FDA‑labeled contraindications to the requested agent

Approval duration

12 months