CurrentUnitedHealthcarePolicy 2025 P 1318-6

Isturisa (osilodrostat) prior authorization for Cushing's syndrome

Defines prior authorization criteria for Isturisa (osilodrostat) for treatment of endogenous Cushing's syndrome in adults when surgery is not an option or was not curative; applies to UnitedHealthcare pharmacy programs.

Policy Summary

PayerUnitedHealthcare

PolicyIsturisa (osilodrostat) prior authorization for Cushing's syndrome

Policy CodePolicy 2025 P 1318-6

Change TypeAnnual review — nomenclature/background updatedno change to clinical intent

Effective DateSep 1, 2025

Next Review Date

Key ActionSubmit prior authorization for Isturisa; approvals are issued for 12 months and reauthorization requires documentation of positive clinical response.

SourceLink

POLICY UPDATE CHANGES

Updated nomenclature, background, and reference with no change to clinical intent (6/2025 review).

12 monthsauthorization period (initial and reauthorization)

Adultsindicated population

Prior auth requiredprogram type

Isturisa (osilodrostat) — Coverage Criteria

Initial Authorization (Isturisa)

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Isturisa will be approved when ALL of the following are met:

ALL of the following

Diagnosis of Cushing's syndrome
One of the following
- Patient is not a candidate for pituitary surgery
- Pituitary surgery has not been curative

Authorization will be issued for 12 months.

Reauthorization (Isturisa)

Isturisa will be reapproved when the following is met:

ALL of the following

Documentation of positive response to Isturisa therapy

Relevant Diagnosis Codes

Relevant diagnosis codesICD-10

E24	Cushing's syndrome (parent code — specific ICD-10-CM subcodes should be used as appropriate)

What Providers Must Do / Watch For

Prior Authorization

Prior authorization required

Prior authorization/notification is required for Isturisa under the UnitedHealthcare pharmacy clinical program; approvals issued for 12 months.

Approval duration: 12 months

Documentation Required

Documentation for reauthorization

For reauthorization, provide documentation demonstrating a positive clinical response to Isturisa therapy.

Denial Risk

Coverage may be automated or limited

UnitedHealthcare may approve initial or reauthorization based solely on prior claim/medication history, diagnosis codes, and/or claim logic; supply limits may apply.

Automated approval and re-approval processes may be used and vary by program or therapeutic class
Supply limits may be in place

Clinical Background

Isturisa (osilodrostat) is a cortisol synthesis inhibitor indicated for the treatment of endogenous hypercortisolemia in adults with Cushing's syndrome for whom surgery is not an option or has not been curative.

Defined Terms

Definitions

TermPositive response

DefinitionNot defined in policy; implies clinical improvement while on therapy and should be supported by documentation in the medical record.

Evidence requirementDocumentation of positive response to Isturisa therapy is required for reauthorization (supporting medical record documentation).

Policy Update Changes

6/2025Annual review (non-material)Latest

Annual review — updated nomenclature, background, and reference with no change to clinical intent.

Policy Metadata and Scope

Policy metadata and key stats

Policy number2025 P 1318-6

SubjectIsturisa (osilodrostat) prior authorization for Cushing's syndrome

Scope summaryDefines prior authorization criteria for Isturisa (osilodrostat) for treatment of endogenous Cushing's syndrome in adults when surgery is not an option or was not curative; applies to UnitedHealthcare pharmacy programs.

Effective date2025-09-01

Last review2025-06

Next review

Coverage stanceCovered with criteria (prior authorization required)

Authorization period12 months (initial and reauthorization)

Indicated populationAdults only

Program typePrior Authorization/Notification; approvals may be automated based on claim history, diagnosis codes, and claim logic; supply limits may apply.