By Counterforce Health Team in Isturisa (osilodrostat) —

How to Get Isturisa (osilodrostat) Covered by Cigna in California: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Isturisa (osilodrostat) Covered by Cigna in California

Eligibility: Isturisa requires prior authorization from Cigna for endogenous Cushing's syndrome (including Cushing's disease) when surgery isn't an option or hasn't been curative. Fastest approval path: Have your endocrinologist complete Cigna's California General Medication Prior Authorization Form with documented hypercortisolism labs, surgical history/contraindication, and medical necessity rationale. Submit via ePA (preferred) or fax to 1-866-873-8279. First step today: Call Cigna Provider Services at 1-800-88CIGNA (882-4462) to verify PA requirements and obtain your specific form.

Table of Contents

  1. Verify Your Plan & Find the Right Forms
  2. Required Forms for Isturisa Prior Authorization
  3. Submission Portals & Electronic Options
  4. Fax Numbers & Mail Addresses
  5. Specialty Pharmacy Setup with Accredo
  6. Support Phone Lines & What to Ask
  7. California Regulatory Support & Appeals
  8. When to Update Your Resources

1. Verify Your Plan & Find the Right Forms

Before starting your Isturisa prior authorization, confirm your specific Cigna plan type and jurisdiction:

Check Your Cigna ID Card:

  • Look for "Cigna HealthCare of California, Inc." or similar CA designation
  • Note if Express Scripts/Accredo is listed as your pharmacy benefit manager
  • Verify the customer service number on the back

Plan Types in California:

  • Commercial/Individual Plans: Use California-specific PA forms and processes
  • Medicare Advantage: Follow CMS coverage determination rules
  • Self-funded ERISA Plans: May have different appeal rights
Tip: Call the customer service number on your ID card first to confirm which forms and submission methods apply to your specific plan.

2. Required Forms for Isturisa Prior Authorization

California General Medication Prior Authorization Form

Cigna uses a California-specific medication PA form (Form 61-211) for all prescription drug prior authorizations in the state.

Key Information Required:

  • Patient demographics, allergies, Cigna ID numbers
  • Prescriber information (NPI, specialty, DEA if required)
  • Medication details: Isturisa (osilodrostat), strength, frequency, quantity
  • Diagnosis with ICD-10: E24.0 (Cushing's syndrome) or more specific codes
  • Prior therapy history: Names, doses, dates, outcomes of previous treatments
  • Clinical justification: Lab values, imaging results, surgical history

Cigna's Isturisa Coverage Criteria

According to Cigna's Cushing's - Isturisa Coverage Position Criteria, approval requires ALL of the following:

  1. Confirmed diagnosis of endogenous Cushing's syndrome (includes Cushing's disease)
  2. Patient is not a surgical candidate, has persistent disease after surgery, is awaiting surgery, or awaiting response to radiotherapy
  3. Prescription by or in consultation with an endocrinologist
  4. Appropriate clinical documentation of hypercortisolism
Note: As of 2025, Cigna no longer requires failure of prior medical therapy for Isturisa approval.

3. Submission Portals & Electronic Options

Electronic Prior Authorization (ePA) - Preferred Method

CoverMyMeds Integration:

  • Cigna California has partnered with CoverMyMeds for electronic PA
  • Allows real-time submission and status tracking
  • Reduces processing time compared to fax/mail

Cigna for Health Care Professionals Portal:

  • Access through the Cigna Health Care Providers section
  • Submit PA requests online once registered
  • Check authorization status and review coverage policies

Required Documentation Upload

When submitting electronically, attach:

  • Completed PA form
  • Office notes documenting diagnosis and treatment history
  • Lab results showing hypercortisolism (24-hour urine cortisol, salivary cortisol, dexamethasone suppression test)
  • Surgical reports or contraindication documentation
  • Endocrinology consultation notes

4. Fax Numbers & Mail Addresses

Primary Fax for Medical Prior Authorization

Cigna Medical PA Fax: 1-866-873-8279

Use this number for:

  • Initial Isturisa prior authorization requests
  • Supporting clinical documentation
  • Status updates on existing requests

Fax Cover Sheet Tips:

  • Include "URGENT" if expedited review needed
  • Reference patient's full name, DOB, and Cigna ID
  • Note "Isturisa (osilodrostat) Prior Authorization Request"
  • Include your NPI and contact information

Mail Address for Appeals

For written medical necessity appeals:

Cigna HealthCare of California, Inc.
National Appeals Unit
PO Box 188011
Chattanooga, TN 37422

Use certified mail for appeal submissions to ensure timely filing within the 180-day window.

5. Specialty Pharmacy Setup with Accredo

Most Cigna plans require Isturisa to be filled through Accredo, Cigna's preferred specialty pharmacy.

New Enrollment Process

  1. Prescriber Action: Send new prescription directly to Accredo (preferred over transfers)
  2. Prior Authorization: Ensure PA is approved before Accredo processes
  3. Patient Enrollment: Accredo will contact you at 877-826-7657 to complete intake
  4. Delivery Setup: Choose home or provider office delivery (where permitted by California law)

Transferring from Another Specialty Pharmacy

Three Options:

  • Call Accredo (877-826-7657) to request transfer from current pharmacy
  • Ask your current pharmacy to transfer to Accredo
  • Have your prescriber send a new prescription to Accredo (often fastest)
Important: If changing insurance plans to Cigna, verify that your existing PA transfers or submit a new one.

6. Support Phone Lines & What to Ask

Provider Support Numbers

Primary Provider Services: 1-800-88CIGNA (882-4462)

  • Check prior authorization requirements
  • Verify status of pending requests
  • Resolve portal access issues
  • Request peer-to-peer review if denied

California-Specific Numbers:

  • Care Management: 800-879-9823 (complex cases, care coordination)
  • Professional Relations: 800-866-6534 (network/administrative issues)
  • California Customer Service: 800-753-0540 (member-facing)

Member Support

National Customer Service: 1-800-997-1654

  • Benefit verification
  • Coverage questions
  • Appeal assistance
  • Pharmacy benefit inquiries

What to Ask When Calling:

  • "Is prior authorization required for Isturisa for my plan?"
  • "What's the status of PA request #[reference number]?"
  • "Can I request an expedited review for medical urgency?"
  • "What additional documentation is needed?"

7. California Regulatory Support & Appeals

Internal Cigna Appeals Process

Timeline for Medical Necessity Appeals:

  • Standard: 30 calendar days for pre-service decisions
  • Expedited: 72 hours for urgent cases
  • Deadline to Appeal: 180 days from denial notice

Required Documentation:

  • Copy of denial letter
  • Additional clinical evidence
  • Specialist support letter
  • Relevant medical literature

California Independent Medical Review (IMR)

If Cigna upholds the denial, California residents can request an Independent Medical Review through the Department of Managed Health Care.

DMHC Help Center: 1-888-466-2219

  • Free IMR process
  • Binding decision on Cigna
  • 45-day standard timeline (7 days expedited)
  • High success rate for specialty drug appeals

Online IMR Application: Available through the DMHC website

Required Documents for IMR

  • All Cigna denial letters
  • Complete medical records
  • Prescriber support letter
  • Clinical guidelines supporting Isturisa use
  • Evidence of Coverage/plan documents
Success Tip: California specialty drug denials are overturned in approximately 60-70% of IMR cases when strong medical documentation is provided.

8. When to Update Your Resources

Form Updates:

Policy Changes:

Contact Information:

  • Provider phone numbers and fax lines may change
  • Verify through the Cigna provider portal before each submission

Clinician Corner: Medical Necessity Letter Checklist

When writing your Isturisa medical necessity letter, include:

Clinical Documentation:

  • ✓ Confirmed endogenous Cushing's syndrome diagnosis
  • ✓ Abnormal cortisol testing results with dates
  • ✓ ACTH levels and imaging findings
  • ✓ Surgical history or contraindications to surgery
  • ✓ Current symptoms and functional impact

Treatment Rationale:

  • ✓ Why surgery is not appropriate or was unsuccessful
  • ✓ Monitoring plan for cortisol levels and side effects
  • ✓ Dose titration strategy per FDA labeling
  • ✓ Expected treatment outcomes and goals

Supporting Evidence:

  • ✓ FDA-approved indication reference
  • ✓ Relevant endocrine society guidelines
  • ✓ Peer-reviewed literature (if applicable)

Counterforce Health: Streamlining Your Appeals Process

Getting specialty medications like Isturisa approved can be complex and time-consuming. Counterforce Health helps patients, clinicians, and specialty pharmacies turn insurance denials into targeted, evidence-backed appeals. The platform analyzes denial letters, plan policies, and clinical notes to identify the specific denial basis and draft point-by-point rebuttals aligned to each payer's requirements.

For medications like Isturisa, Counterforce Health pulls the right evidence—FDA labeling, peer-reviewed studies, specialty guidelines, and drug compendia—and weaves them into appeals with the required clinical facts. This includes diagnosis codes, prior treatment failures, contraindications, and treatment goals that payers specifically look for in their coverage decisions.

FAQ: Common Questions About Cigna Coverage for Isturisa in California

Q: How long does Cigna prior authorization take for Isturisa?
A: Standard reviews are completed within 2 business days once all documentation is received. Expedited reviews for urgent cases can be completed within 24 hours.

Q: What if Isturisa is non-formulary on my Cigna plan?
A: You can request a formulary exception using the same California PA form. Your prescriber must document that formulary alternatives were tried and were ineffective or detrimental.

Q: Can I get an expedited appeal if denied?
A: Yes, if delay would seriously jeopardize your health or if you're currently stable on Isturisa and interruption would harm your condition.

Q: Does California step therapy apply to Isturisa?
A: Cigna's current policy doesn't require prior medical therapy failure for Isturisa, but document any previous treatments to strengthen your case.

Q: What if I'm switching from another insurance to Cigna?
A: Your previous PA likely won't transfer automatically. Submit a new request with current clinical documentation and mention your stable response to treatment.

Q: How much does the California IMR process cost?
A: The Independent Medical Review is completely free to patients. Cigna pays all costs associated with the independent physician review.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Coverage policies and procedures may vary by plan and change over time. Always verify current requirements with Cigna and consult with your healthcare provider regarding treatment decisions. For additional assistance with insurance coverage in California, contact the Department of Managed Health Care at 1-888-466-2219 or visit healthhelp.ca.gov.

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