WebRequests for prior authorization of Korlym will be approved as follows: 1. Initial approvals of requests for prior authorization of Korlym will be limited to 8 months of therapy … WebCriteria will be applied consistent with current AASLD/IDSA guidance PART B PREREQUSITE N/A PAGE 21 LAST UPDATED 01/2024. LEDIPASVIR/SOFOSBUVIR (HARVONI) ... KORLYM PA INDICATION INDICATOR 3 - All Medically-Accepted Indications OFF LABEL USES N/A EXCLUSION CRITERIA N/A REQUIRED MEDICAL …
Self-Administered Specialty Pharmacy Drug List
WebOtherwise please return completed form to: UPMC HEALTH PLAN PHARMACY SERVICES PHONE 800-396-4139 FAX 412-454-7722 Web1. Currently receiving medication via PA Health & Wellness benefit or member has previously met all initial approval criteria; or the Continuity of Care policy … therapeutic pedagogy
2024 Service Benefit Plan Specialty Drug List
WebCorcept Therapeutics Inc. is a pharmaceutical company engaged in the discovery, development and commercialization of drugs for the treatment of severe metabolic, psychiatric and oncologic disorders. Corcept has focused on the adverse effects of excess cortisol, studying new compounds that may mitigate those effects. Its executive team is … WebKorlym (mifepristone) Effective 10/01/2024 . Plan ☐ MassHealth UPPL ... Authorization may be granted if the member meets all following criteria and documentation has been ... 7/22/20 – Reviewed and Updated July P&T Mtg; Updated Program Type to PA and QL. Effective 10/01/2024 . 9/16/20 – Reviewed at September P&T, Updated ... WebKorlymis indicated to control hyperglycemia secondary to hypercortisolism in adult patients with endogenous Cushing's syndrome who have type 2 diabetes mellitus or glucose intolerance and have failed surgery or are not candidates for surgery. signs of heat illness