Isturisa — Medical Mutual

Initial criteria

• Patient age ≥ 18 years; AND
• Patient meets ONE of the following: a) According to the prescriber, the patient is not a candidate for surgery or surgery has not been curative; OR b) Patient is awaiting surgery for endogenous Cushing’s syndrome; OR c) Patient is awaiting therapeutic response after radiotherapy for endogenous Cushing’s syndrome; AND
• Isturisa is prescribed by or in consultation with an endocrinologist or a physician who specializes in the treatment of Cushing’s syndromes; AND
• Baseline urinary free cortisol is elevated; AND
• Baseline laboratory testing, including serum potassium and serum magnesium, have been completed

Reauthorization criteria

• Patient age ≥ 18 years; AND
• Patient meets ONE of the following: a) According to the prescriber, the patient is not a candidate for surgery or surgery has not been curative; OR b) Patient is awaiting surgery for endogenous Cushing’s syndrome; OR c) Patient is awaiting therapeutic response after radiotherapy for endogenous Cushing’s syndrome; AND
• Isturisa is prescribed by or in consultation with an endocrinologist or a physician who specializes in the treatment of Cushing’s syndrome; AND
• Documentation of positive response to therapy, evidenced by a decrease in urinary free cortisol from baseline

Approval duration

initial 6 months; reauth 1 year