Posted in Cinga Insurance

Cigna- Drug Formulary Changes effective January 2022

In this blog post we will explore the changes that affect Specialty medications for both medical and pharmacy benefits.

What does this mean for providers?

Please check to see which changes apply to your patients. Please contact Cigna or check on their website for more specialty drug changes and any other suitable alternatives.

What does this mean for patients?

Patients that get their medication from a pharmacy may see higher out of pocket costs. Please contact your healthcare provider to see if there are any other suitable alternatives.  

Medical Benefit Specialty Medications:

  1. Immuno globulins: Cigna preferred drugs are Flebogamma, Gamunex-C, Gammaked, Gammaplex, Hizentra, Octagam, and Privigen. Any other Immuno globulins that are on the non-preferred list will require a step therapy. Cinga is letting the current authorizations for non-preferred immune globulins be active until the authorization expiration date. After which the provider will need to reevaluate the patient for any preferred drugs.
  2. Iron Replacement: Cigna will require a prior authorization for following iron replacement drugs-Feraheme, Injectafer, and Monoferric. These drug will also have step therapy that will go through Verofer. This requirement does NOT apply for patients with dialysis-dependent chronic kidney disease. IF the patient has a pharmacy benefit (Advantage and Performance Formularies) will require a prior authorization WITH a step therapy.
  3. Neutropenia: Udenyca will no longer will be on the preferred list. Patients that currently take Udenyca are allowed to keep taking it until their current authorization will expire. (Patients that do have a three-tier pharmacy benefit MAY see their cost share change, if they fill the Rx under their pharmacy benefit).  Cigna will make Ziextenzo a preferred medication and will be added to the list with Neulasta, Neulasta Onpro, and Nyvepria.
  4. Pulmonary Hypertension: Remodulin-will require a step therapy through treprostinil (generic equivalent)
  5. Transplant Therapy: Nulojix will require precertification and may require a site of care review.

Pharmacy Benefit Specialty Medications:

  1. HIV medications: Cigna will REMOVE the following medications from the formulary-Kaletra, Atripia, Emritva, Intelence, and Symfi/Symfi Lo.
  2. Multiple Sclerosis: For patients that start the treatment and providers that initiate a new prior authorization-all single-source brands (oral, injectable, and infusion medications, will have a step therapy requirement.
  3. Oncology: Cigna will put Tasigna on a non-preferred list. For any new treatment and initiated prior authorizations there will be a step therapy requirement.

For a full list of Medication/drug formulary changes for the year 2022, please click here.

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Posted in Cinga Insurance, Training, Updates

Cigna: Smoking Cessation is covered-Commercial plans

Recently, Cigna began to implement clinical quality Initials that align with NCQA Medical Assistance and Smoking and Tobacco Use Cessation Quality Measure.

As per ACA, smoking cessation is a covered service. Cigna is encouraging the providers to identify, screen and treat for tobacco dependence.

After the Provider will identify the patient, Cigna will reach out to the patient, and encourage them to quit smoking and seek support from their provider.

Which codes to use?

As per Cigna Preventative Care Services Policy: (A004)– these codes can be used with any DX code.

Note: although, Cigna states that these services are covered free of charge to the patient, if the provider performs these services on the same DOS with Preventative EM code then some of these tobacco cessation treatment services could be subject to additional out of pocket costs for your patients. To avoid this, providers are allowed to bill the smoking cessation codes on a separate encounter as preventative services (EM codes).

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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.

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