pasireotide diaspartate — United Healthcare

Initial criteria

• Diagnosis of endogenous Cushing’s disease (i.e., hypercortisolism is not a result of chronic administration of high dose glucocorticoids)
• AND
• One of the following:
• Pituitary surgery has not been curative for the patient
• OR
• Patient is not a candidate for pituitary surgery

Reauthorization criteria

• Documentation of positive clinical response to Signifor therapy

Approval duration

12 months