Adrenal hyperplasia agents (Crenessity / crinecerfont) prior authorization
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Prior authorization criteria and coverage summary for crinecerfont (Crenessity) for Georgia Medicaid fee-for-service members with classic congenital adrenal hyperplasia. Specifies age/weight, diagnostic confirmation, and authorization lengths.
No material clinical or coverage changes in this revision.
Coverage Criteria
Initial Therapy
Covered when ALL of the following are met:
Exceptions to these conditions of coverage are considered through the prior authorization process. Providers may initiate the prior authorization request by calling OptumRx at 1-866-525-5827.
Initial Authorization
Initial Authorization
Initial authorization terms
Reauthorization / Continuation Criteria
Reauthorization
Reauthorization requirements
Provider Actions and Prior Authorization
Prior authorization required
Prior authorization is required before initiating Crenessity. Initial approvals are for 6 months; reauthorization approvals are for 1 year. The PA may be initiated by calling OptumRx at 1-866-525-5827.
No step therapy specified
No step therapy requirements are specified for Crenessity in this policy summary.
Documentation of 21-hydroxylase deficiency and concomitant therapy
Provide documentation confirming classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency based on serum 17-hydroxyprogesterone and cortisol levels, and evidence that the member will receive concomitant glucocorticoid replacement therapy.
Denial risk for unmet clinical criteria
Requests that do not meet the clinical coverage criteria may be denied; exceptions can be considered through the prior authorization process.
- Clinical criteria include: member ≥ 4 years of age, weight ≥ 10 kg, diagnosis of classic CAH confirmed by 21-hydroxylase deficiency via 17-OHP and cortisol, and plan for concomitant glucocorticoid replacement therapy.
Definitions
Quantity Limits
Background
Classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency leads to impaired cortisol synthesis and elevated 17-hydroxyprogesterone. Crinecerfont (Crenessity) is indicated for members with confirmed 21-hydroxylase deficiency and is intended to be used in conjunction with concomitant glucocorticoid replacement therapy.
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