Signifor (pasireotide) — CareFirst (Caremark)
Cushing’s disease for adult patients for whom pituitary surgery is not an option or has not been curative
Initial criteria
- Member has a diagnosis of Cushing’s disease
- Member is an adult (age ≥ 18 years)
- Member has had pituitary surgery that was not curative OR is not a candidate for surgery
- Pretreatment cortisol level provided from one of the following tests: Urinary free cortisol (UFC), Late-night salivary cortisol (LNSC), 1 mg overnight dexamethasone suppression test (DST), or Longer, low dose DST (2 mg per day for 48 hours)
Reauthorization criteria
- Member demonstrates lower cortisol levels since the start of therapy per one of the following tests: Urinary free cortisol (UFC), Late-night salivary cortisol (LNSC), 1 mg overnight dexamethasone suppression test (DST), or Longer, low dose DST (2 mg per day for 48 hours)
- OR member shows improvement in signs or symptoms of the disease
Approval duration
Initial: 6 months; Reauthorization: 12 months