Posted in Cinga Insurance, Training, Updates

Cigna: RAMICADE Reimbursement Policy Change

Are you a provider that administers RAMICADE for Cigna patients? Then this blog post is for you!


As of July 2021 Cigna removed RAMICADE from its preferred medications list. This change will apply to Cigna Commercial Plans.


This change will Apply to Individual and Family Plans on January 1,2022 and thereafter.  


What providers should do?

IF you are a provider that currently accepts CIGNA Commercial plan patients in your office, CIGNA encourages you to work with your Cigna Patients to switch to either AVSOLA or INFLECTRA.

Do I need a new authorization starting 07/01/2021?

No. Providers are allowed to administer either AVSOLA or INFLECTRA without any further action: provided that the patient meets medical necessity and there is no change in dosing, frequency or site of services.

What is the Authorization time frame for AVSOLA and INFLECTRA?

July 1, 2021 to May 1, 2022.

How can a provider obtain a copy of the authorization?

Please call 1800-882-4462 Cigna Coverage Review Department, to request a letter of authorization.


What if I RAMICADE is medically necessary for my patients?

If provider believes that a non-preferred medication is medically necessary for the patient, provider can contact Cigna Coverage Review Department and request a medical necessity review. Provider can also request medical review through CovermyMeds or Surescripts.


Who can I contact for additional information?

Please contact Accredo: 1866-759-1557 or CuraScript SD 1877-599-7748 or any other participating specialty pharmacy.

Do you find this content useful? Follow my blog for more medical billing and coding updates. As well as medical coverage/reimbursement policy updates.


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Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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