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The Policy VaultThe Policy Vault

mifepristone tablets — Medica

endogenous Cushing’s syndrome with type 2 diabetes mellitus or glucose intolerance in adults who have failed surgery or are not candidates for surgery

Preferred products

  • generic mifepristone tablets

Initial criteria

  • Patient meets the standard Cushing’s – Mifepristone Prior Authorization Policy criteria
  • If requesting a Non-Preferred Product, patient has tried a Preferred Product OR meets exception criteria

Reauthorization criteria

  • Patient continues to meet the standard Prior Authorization Policy criteria

Approval duration

1 year