mifepristone — CareFirst (Caremark)
Cushing’s syndrome/disease with type 2 diabetes mellitus or glucose intolerance to control hyperglycemia secondary to hypercortisolism
Initial criteria
- Member has type 2 diabetes mellitus or glucose intolerance
- The requested drug is being prescribed to control hyperglycemia secondary to hypercortisolism
- Member has had surgery that was not curative OR member is not a candidate for surgery
- If the member is able to become pregnant, a negative pregnancy test is required before initiating therapy
Reauthorization criteria
- Member has achieved or maintained an adequate positive response, or there is improvement in signs and symptoms of the condition
Approval duration
Initial: 6 months; Reauthorization: 12 months