Korlym — Blue Cross Blue Shield of Alabama

Initial criteria

• Patient has a diagnosis of Cushing’s syndrome
• Patient age is within FDA labeling for the requested indication OR there is support for use at the patient’s age
• Patient has ONE of the following: type 2 diabetes mellitus OR glucose intolerance defined by a 2‑hr OGTT plasma glucose 140–199 mg/dL
• Patient has had inadequate response to surgical resection OR is not a candidate for surgical resection
• If request is for brand Korlym when generic mifepristone is available: ONE of the following – intolerance or hypersensitivity to the generic not expected with brand, FDA‑labeled contraindication to the generic not expected with brand, or support for use of brand over generic
• Prescriber is a specialist in the area of the diagnosis (e.g., endocrinologist) or has consulted with such specialist
• Patient does NOT have any FDA‑labeled contraindications to mifepristone
• Requested dose does NOT exceed 20 mg/kg/day

Reauthorization criteria

• Patient was previously approved for the requested agent through the plan’s prior‑authorization process
• Patient has had clinical benefit with the requested agent
• If request is for brand Korlym when generic mifepristone is available: ONE of the following – intolerance or hypersensitivity to the generic not expected with brand, FDA‑labeled contraindication to the generic not expected with brand, or support for use of brand over generic
• Prescriber is a specialist in the area of the diagnosis (e.g., endocrinologist) or has consulted with such specialist
• Patient does NOT have any FDA‑labeled contraindications to mifepristone
• Requested dose does NOT exceed 20 mg/kg/day

Approval duration

initial 6 months; renewal 12 months