CurrentCignaPolicy N/A

Isturisa (osilodrostat) — Prior Authorization for Endogenous Cushing's Syndrome

This policy governs prior authorization and coverage criteria for Isturisa (osilodrostat tablets) for treatment of endogenous Cushing's syndrome in adults under Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyIsturisa (osilodrostat) — Prior Authorization for Endogenous Cushing's Syndrome

Policy CodePolicy N/A

Change TypeClinical/coverage updates (material)

Effective DateN/A

Next Review DateApr 1, 2026

Key ActionObtain prior authorization and document that the patient is ≥18 years and is either not a candidate for surgery, awaiting surgery, or awaiting radiotherapy response, with prescription by or in consultation with an endocrinologist.

SourceLink

POLICY UPDATE CHANGES

Patients awaiting surgery and patients awaiting therapeutic response after radiotherapy were added as options for approval.

Endogenous Cushing's syndrome was moved from 'Other Uses with Supportive Evidence' to 'FDA-Approved Indication'.

Requirement for a trial of one previous therapy was removed for the FDA-approved indication.

Cushing's disease is noted to be included within the endogenous Cushing's syndrome indication.

1 yearstandard approval duration

≥18minimum age

specialistprescriber requirement

FDA-approvedindication status

Policy Summary

PayerCigna

PolicyIsturisa (osilodrostat) — Prior Authorization for Endogenous Cushing's Syndrome

Policy CodePolicy N/A

Change TypeClinical/coverage updates (material)

Effective DateN/A

Next Review DateApr 1, 2026

SourceLink

On This Page

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Coverage Criteria for Isturisa (osilodrostat)

inv-01: COVERAGE CRITERIA — Covered when ALL of the following are met

Covered when ALL of the following are met

FDA-Approved Indication: Endogenous Cushing's Syndrome

A: Patient is >= 18 years of age
B
- B.i: Prescriber states the patient is not a candidate for surgery or surgery has not been curative
- B.ii: Patient is awaiting surgery for endogenous Cushing's syndrome
- B.iii: Patient is awaiting therapeutic response after radiotherapy for endogenous Cushing's syndrome
C: Medication is prescribed by or in consultation with an endocrinologist or a physician who specializes in the treatment of endogenous Cushing's syndrome

Prescriber specialty and authorization: Prior authorization is required; medication must be prescribed by or in consultation with a physician who specializes in the condition (e.g., endocrinologist)

Approvals are provided for the duration noted (FDA-approved indication: 1 year)

CONDITIONS NOT COVERED is listed for Isturisa in the policy; however, the document provides only the section header and does not specify particular diagnoses or situations that are excluded beyond the header itself.

Reimbursement is not allowed for services billed for conditions or diagnoses that are not covered under this coverage policy. Claims submitted without the covered diagnosis or procedure codes required by the policy will be denied as not covered. Providers must bill using the most appropriate codes as of the submission date and follow the applicable benefit plan terms.

Coding and Approval Duration

Covered CPT Codesmixed

No codes listed

inv-05: Approval duration — 1 year for FDA-approved indication

Approval durationApprove for 1 year for the FDA‑approved indication of endogenous Cushing's syndrome

Month definitionWhen approvals are authorized in months, 1 month = 30 days

Prescriber requirement tied to durationApprovals require the medication to be prescribed by or in consultation with an endocrinologist or a physician specializing in endogenous Cushing's syndrome

Provider Actions, Prior Authorization and Documentation

Prior Authorization

Prior Authorization Required

Prior Authorization is required for prescription benefit coverage of Isturisa (osilodrostat). Approvals are provided for the durations noted in the policy (for FDA‑approved endogenous Cushing's syndrome: approve for 1 year). When approval is authorized in months, 1 month = 30 days.

Isturisa (osilodrostat) — prior authorization required
Approval duration: FDA‑approved endogenous Cushing's syndrome — 1 year

Documentation Required

Prescriber and Authorization Documentation

Because of the specialized skills required for evaluation, diagnosis, and monitoring of patients treated with Isturisa, the medication must be prescribed by or in consultation with a physician who specializes in the condition being treated. For endogenous Cushing's syndrome the medication must be prescribed by or in consultation with an endocrinologist or a physician who specializes in treatment of endogenous Cushing's syndrome. Prior authorization documentation must reflect this.

Background

Cushing's syndrome is a state of hypercortisolism characterized by excessive circulating cortisol. It can be endogenous (for example, from pituitary adenomas as in Cushing's disease, adrenal tumors, or ectopic ACTH production) or exogenous due to glucocorticoid therapy. Treatment goals include normalization of cortisol levels, long-term disease control, prevention of recurrence, and reversal of clinical features. When feasible, first-line therapy is surgical tumor resection; medical therapy such as Isturisa (osilodrostat) is an option when surgery is not possible or is not curative.

Definitions

inv-11: Endogenous Cushing's syndrome — definition including pituitary, adrenal, ectopic ACTH sources and Cushing's disease

DefinitionEndogenous Cushing's syndrome refers to hypercortisolism originating from internal sources (e.g., pituitary adenomas, adrenal tumors, ectopic ACTH) and includes Cushing's disease (pituitary‑adenoma–driven hypercortisolism).

Common causeCushing's disease is the most common type of ACTH‑dependent endogenous Cushing's syndrome (caused by pituitary adenomas).

Clinical goalTreatment goals include normalizing cortisol excess, long‑term disease control, preventing recurrence, and reversing clinical features; first‑line therapy is tumor resection when feasible.

inv-12: Isturisa (osilodrostat) — drug description and indication when surgery is not an option or not curative

Drug class and generic nameIsturisa (osilodrostat) is a cortisol synthesis inhibitor.