Korlym — Blue Cross Blue Shield of Oklahoma

Cushing’s syndrome with type 2 diabetes mellitus or glucose intolerance

Preferred products

Patient has a diagnosis of Cushing’s syndrome AND
If the patient has an FDA labeled indication, then ONE of the following: (a) patient’s age is within FDA labeling OR (b) support for use for the patient’s age for the requested indication AND
ONE of the following: (a) patient has type 2 diabetes mellitus OR (b) patient has glucose intolerance defined by 2-hr glucose tolerance test plasma glucose 140–199 mg/dL AND
ONE of the following: (a) inadequate response to surgical resection OR (b) not a candidate for surgical resection AND
If brand Korlym requested, ONE of the following relative to generic mifepristone: (a) currently treated and stable on brand, (b) inadequate response to generic not expected with brand, (c) generic discontinued for lack of efficacy or adverse event, (d) intolerance or hypersensitivity to generic, (e) FDA labeled contraindication to generic, (f) generic expected to be ineffective, cause adherence barrier, worsen comorbidity, or harm, (g) not in best interest based on medical necessity, (h) tried another drug in same class discontinued for lack of efficacy or adverse event AND
Prescriber is an endocrinologist or has consulted one AND
No FDA labeled contraindications to requested agent AND
Requested dose ≤ 20 mg/kg/day

Patient previously approved through prior authorization AND
Patient has had clinical benefit with requested agent AND
If brand Korlym requested, ONE of the following relative to generic mifepristone: (a) currently treated and stable, (b) inadequate response to generic, (c) generic discontinued for lack of efficacy or adverse event, (d) intolerance to generic, (e) contraindication to generic, (f) generic expected to be ineffective or cause harm, (g) not in best interest based on medical necessity, (h) tried another drug in same class discontinued for lack of efficacy or adverse event AND
Prescriber is an endocrinologist or has consulted with one AND
No FDA labeled contraindications AND
Requested dose ≤ 20 mg/kg/day

6–12 months