CurrentUnitedHealthcarePolicy N/A

Crenessity (crinecerfont) prior authorization

Defines prior authorization and reauthorization requirements for Crenessity (crinecerfont) for treatment of classic congenital adrenal hyperplasia in members 4 years and older who receive concomitant glucocorticoid replacement.

Policy Summary

PayerUnitedHealthcare

PolicyCrenessity (crinecerfont) prior authorization

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMay 1, 2026

Next Review DateFeb 1, 2026

Key ActionObtain prior authorization: confirm diagnosis of classic CAH, patient is ≥4 years, and concomitant glucocorticoid replacement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

≥4minimum patient age for coverage

12 moauthorization duration

2/2025;2/2026P&T approval dates

PI Dec 2024primary reference

Coverage Criteria for Crenessity (crinecerfont)

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inv-02: Continuation/Reauthorization — Covered when ALL of the following are met

Covered when ALL of the following are met.

Reauthorization: a. Documentation of positive clinical response to Crenessity therapy

Reauthorization: b. Patient will continue to receive concomitant glucocorticoid replacement (e.g., dexamethasone, hydrocortisone, methylprednisolone, prednisone, prednisolone)

Authorization will be issued for 12 months.

Initial Therapy

inv-10: Initial Therapy — Initial approval criteria

Initial approval when ALL criteria are met.

Initial Therapy: Diagnosis of classic congenital adrenal hyperplasia (CAH)

Initial Therapy: Patient is 4 years of age or older

Initial Therapy: Patient will receive concomitant glucocorticoid replacement (e.g., dexamethasone, hydrocortisone, methylprednisolone, prednisone, prednisolone)

Reauthorization / Continuation Criteria

inv-11: Reauthorization — Reauthorization conditions for continued coverage

Reauthorization requires ALL of the following.

Reauthorization: Documentation of positive clinical response to Crenessity therapy

Reauthorization: Patient will continue to receive concomitant glucocorticoid replacement (e.g., dexamethasone, hydrocortisone, methylprednisolone, prednisone, prednisolone)

Authorization will be issued for 12 months.

Provider Actions and Prior Authorization Requirements

Prior Authorization

Prior Authorization Required — Initial

Prior Authorization — Initial: Prior authorization is required for initial Crenessity therapy. Initial approval will be granted only when ALL of the following are documented: diagnosis of classic congenital adrenal hyperplasia (CAH); patient is 4 years of age or older; and the patient will receive concomitant glucocorticoid replacement (e.g., dexamethasone, hydrocortisone, methylprednisolone, prednisone, prednisolone).

Diagnosis: classic congenital adrenal hyperplasia (CAH)
Age: ≥ 4 years
Concomitant therapy: documented glucocorticoid replacement (e.g., dexamethasone, hydrocortisone, methylprednisolone, prednisone, prednisolone)

Denial Risk

Initial Eligibility — Denial Risk

Initial eligibility: Lack of documentation of a diagnosis of classic CAH or documentation showing the patient is under 4 years of age may result in denial of the prior authorization request. Providers should ensure required diagnostic and age documentation are included with the submission.

Denial risk if no documented classic CAH diagnosis
Denial risk if patient < 4 years

Billing Rule

Automated Approval and Supply Limits

Automated approval and supply limits: UnitedHealthcare may use previous claim/medication history, diagnosis codes (ICD-10), and/or claim logic to approve initial or reauthorization requests per program rules. Automated approval/re-approval processes and supply limits may vary by program and therapeutic class; providers should verify program-specific rules and any applicable state or plan mandates.

Approvals may be based solely on prior claim/medication history, ICD-10 diagnosis codes, and/or claim logic
Supply limits may apply and vary by program

Background

Crenessity (crinecerfont) is a corticotropin‑releasing factor type 1 (CRF1) receptor antagonist indicated as adjunctive therapy to glucocorticoid replacement to control androgens in adults and pediatric patients aged 4 years and older with classic congenital adrenal hyperplasia (CAH). It is intended for use alongside standard glucocorticoid replacement (for example, hydrocortisone, dexamethasone, methylprednisolone, prednisone or prednisolone) to manage androgen excess associated with CAH. The policy effective date is 5/1/2026, with P&T review dates noted in the program record.

Definitions

inv-09: Classic congenital adrenal hyperplasia (CAH) — definition and clinical context

DefinitionClassic congenital adrenal hyperplasia (CAH) is a genetic disorder causing defects in adrenal steroidogenesis leading to androgen excess; managed with glucocorticoid replacement and, as adjunct, agents such as crinecerfont (Crenessity).

Indication contextCrenessity is indicated as adjunctive treatment to glucocorticoid replacement to control androgens in adults and pediatric patients 4 years of age and older with classic CAH.

Age considerationPolicy and indication specify patients must be 4 years of age or older for use of Crenessity in classic CAH.

Clinical goalControl of androgen excess in patients with classic CAH when used in combination with glucocorticoid replacement.

Quantity Limits

inv-12: Crenessity (crinecerfont) — Supply limits may apply (quantity/dispense constraints)

Quantity limit statementSupply limits may be in place for Crenessity; programs may apply automated approval or refills based on claims/medication history and diagnosis codes.

Approval automationUnitedHealthcare may use automated approval and re-approval processes that vary by program and therapeutic class, which can affect quantity dispensed.

Program variabilityUse of automated approval and re-approval processes and any supply limits varies by program and/or therapeutic class.