Alkindi Sprinkle — Highmark
adrenocortical insufficiency
Preferred products
- oral generic hydrocortisone tablets
Initial criteria
- age ≤ 17 years
- diagnosis of adrenocortical insufficiency (ICD-10: E27)
- experienced therapeutic failure or intolerance to plan-preferred oral generic hydrocortisone tablets
Reauthorization criteria
- prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
initial up to 4 months; reauthorization up to 12 months (Delaware Commercial fully-insured and ACA members up to 12 months initial)