How to Help Your Patients Find Lysodren In Stock: A Provider's Guide

As a prescriber managing a patient with adrenocortical carcinoma (ACC), one of the most critical — and often underappreciated — aspects of care is ensuring uninterrupted access to Lysodren (mitotane). This may seem like an administrative task, but it is deeply clinical: Lysodren is the only FDA-approved treatment for ACC, and access delays directly affect treatment outcomes. This guide walks through every step of the process, from specialty pharmacy enrollment to patient financial support.

Step 1: Route the Prescription to the Right Place

The single most important thing you can do to avoid Lysodren access problems is to route the prescription directly to the specialty pharmacy network from your office — not to a retail pharmacy. When patients take a Lysodren prescription to their local CVS or Walgreens, they will almost always be turned away because retail pharmacies cannot order Lysodren through standard wholesale channels.

Direct your office staff to:

E-prescribe or fax the Lysodren prescription directly to the specialty pharmacy in the Direct Success network that your patient will use

Contact Direct Success Inc. at 1-844-597-6373 or Distribution@DSuccess.com to identify the dispensing pharmacy and get enrollment forms

Do not send the patient to a retail pharmacy — this causes confusion and delays

Step 2: Initiate Prior Authorization Immediately

Do not wait for the pharmacy to request the prior authorization. Your office should submit the PA simultaneously with the prescription. For Lysodren, a strong PA includes:

The diagnosis: ICD-10 code C74.0x (malignant neoplasm of cortex of adrenal gland), including laterality

Inoperability statement: Lysodren is FDA-approved for inoperable ACC — document why surgery is not an option

No therapeutic alternatives: Mitotane is the only FDA-approved drug for ACC — there is no step therapy requirement that applies

Clinical urgency letter: A signed letter of medical necessity can significantly accelerate PA approval

If the PA is denied, appeal immediately and request an expedited peer-to-peer review. Insurers are generally not in a strong position to deny the only FDA-approved drug for a rare cancer, but bureaucratic inertia is common. The Direct Success patient support team can also assist with PA navigation.

Step 3: Enroll Patients in Financial Assistance Programs

The cost of Lysodren can be a major access barrier. A proactive approach is to enroll patients in financial support programs before their first dispense. Your team should ask about insurance status and initiate financial support discussions at the same time as the clinical plan:

Commercial insurance patients: Call 1-844-597-6373. Patients typically pay no more than $80/month with manufacturer copay support.

Uninsured/underinsured patients: Additional patient assistance programs are available through ESTEVE/Direct Success for patients who do not qualify for or cannot afford standard coverage. Call the same number.

Medicare patients: Lysodren is Tier 5 under most Part D plans. With the 2025 Medicare Part D $2,000 annual out-of-pocket cap, most patients reach catastrophic coverage during the year. The PAN Foundation also provides grants for Medicare patients.

Step 4: Counsel Patients on the Unique Aspects of Lysodren Therapy

Many patients are unfamiliar with how different Lysodren therapy is from typical medications. Proactive counseling reduces confusion and adherence problems:

Take with high-fat food: Lysodren absorption is enhanced by high-fat meals. Timing of doses relative to meals must be consistent.

Hazardous drug handling: Caregivers must wear disposable gloves when handling tablets. Crushed or broken tablets should not be handled with bare skin.

Adrenal crisis awareness: All patients should carry an emergency hydrocortisone injection kit and a medical alert card. Adrenal crisis risk increases with illness, surgery, or physical stress — and can be life-threatening.

Contraception counseling: Lysodren renders hormonal contraceptives unreliable. Women of reproductive potential must use non-hormonal contraception during treatment and until mitotane plasma levels are undetectable.

Plasma level monitoring: Patients should understand that blood tests every 2 weeks are required during titration. Target plasma level is 14–20 mg/L; levels above 20 mg/L are associated with CNS toxicity.

Step 5: Proactively Manage Refills

Refill delays are among the most common — and preventable — causes of Lysodren access problems. Your office should:

Track refill timelines for all Lysodren patients and send early refill authorization at least 3 weeks before the expected run-out date

Remind patients to contact the specialty pharmacy 2–3 weeks before their supply runs out — not at the last minute

Update insurance information promptly if a patient changes plans — specialty pharmacy enrollment may need to be re-initiated

How medfinder Can Support Your Patients

When your patients report they can't find their Lysodren, medfinder can help. medfinder is a paid service that calls pharmacies on behalf of the patient to find which ones can fill their prescription, then texts the results. For a medication as hard to find as Lysodren, this kind of targeted pharmacy search can save patients hours of frustration at a deeply stressful time. Recommend medfinder.com to your patients who are experiencing access difficulties.

See also: Lysodren Shortage: What Providers and Prescribers Need to Know in 2026.