Medicare AdvantagePrior AuthMedium impact
Isturisa® (osilodrostat) (Revised)
Humana·Endocrinology·Medicare Advantage
Effective date
Apr 22, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Isturisa® (osilodrostat) prior authorization policy effective April 22, 2026, expanding coverage to include endogenous hypercortisolemia with Cushing's syndrome (in addition to Cushing's disease). Both indications now require prior authorization confirming patient age ≥18, appropriate diagnosis, and failure of or ineligibility for surgery. Approval duration covers initial and renewal plan years.
Action Required
By April 22, 2026: Billing and prior authorization teams must update workflows to recognize TWO separate coverage criteria pathways for Isturisa®: (1) Cushing's disease requiring failed/ineligible pituitary surgery, and (2) Endogenous hypercortisolemia with Cushing's syndrome requiring failed/ineligible surgery (non-pituitary). Update PA submission templates and clinical criteria in billing system to capture both indications. Verify that prior auth requests include: member age verification (≥18), diagnosis code confirmation, and documentation of prior surgical intervention status or reason surgery is not an option. Train billing staff and providers on the April 16, 2025 FDA label expansion. Flag claims for prior authorization denial if any required criterion is missing. Failure to implement updated PA requirements will result in claim denials for this specialty pharmaceutical.