Recorlev — Medical Mutual

Endogenous Cushing’s Syndrome

Initial criteria

Patient is age ≥ 18 years; AND
Baseline urinary free cortisol is elevated; AND
Patient meets ONE of the following (i, ii, OR iii): i. According to the prescriber, the patient is not a candidate for surgery or surgery has not been curative; OR ii. Patient is awaiting surgery for endogenous Cushing’s Syndrome; OR iii. Patient is awaiting therapeutic response after radiotherapy for endogenous Cushing’s Syndrome; AND
Patient has tried ketoconazole tablets; AND
Baseline laboratory testing, including liver function tests (LFTs), electrocardiogram (ECG), serum potassium, and serum magnesium, have been completed; AND
The medication is prescribed by or in consultation with an endocrinologist or a physician who specializes in the treatment of endogenous Cushing’s syndrome

Patient is age ≥ 18 years; AND
According to the prescriber, the patient is not a candidate for surgery or surgery has not been curative; AND
Patient has tried ketoconazole tablets; AND
The medication is prescribed by or in consultation with an endocrinologist or a physician who specializes in the treatment of endogenous Cushing’s syndrome; AND
The patient has experienced a positive response to therapy, evidenced by a decrease in urinary free cortisol from baseline

initial: 6 months; reauth: 1 year