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Cigna September 2017 Medical Policy Updates

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Policy Updates September 2017

Medical Coverage Policy
No updates for September 2017.
Pharmacy (Drugs & Biologics) Policies
Unless otherwise noted, the following pharmacy (drugs & biologics) coverage policies were modified effective September 15, 2017:
Ivacaftor, Lumacaftor/Ivacaftor – (1207) Modified
  • Important changes in coverage criteria:
    • Added coverage to align to FDA-approved expanded indication for additional cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations.
    • Removed trade name from title.
Oncology Medications – (1403) Modified
  • Important change in coverage criteria:
    • Added Idhifa (enasidenib).
Pharmacy Prior Authorization – (1407) Modified
  • Important changes in coverage criteria:
    • Added criteria for:
      • Adrenaclick
      • Auvi-Q
      • EpiPen
      • EpiPen Jr.
      • Relistor tablet
Rituximab for Non-Oncology Indications – (5108) Modified
  • Important changes in coverage criteria:
    • Added statement that rituximab is experimental, investigational, or unproven (EIU) for:
      • lupus nephritis
      • membranous nephropathy
      • multiple sclerosis
      • myasthenia gravis
      • Sjogren’s Syndrome
      • systemic lupus erythematosus (SLE)
    • Added statement that Rituxan Hycela™ is EIU for non-oncology indications.
    • Removed trade name from title.
Step Therapy – (1109) Modified
  • Important change in coverage criteria:
    • Removed epinephrine auto-injector class.
Administrative Policies
Abortion – (A006)

 

 New
  • New policy, effective September 21, 2017:
    • Clarifies definitions and codes associated with abortion.
    • Retiring Abortion T107 Tool to Administer Benefit Standards (TABS).
Preventive Care Services – (A004) Modified
  • Important changes:
    • CPT codes 86480 and 86481
    • Adults at risk
  • Removed reference to HPV vaccine gender edit.

Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.

Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!

Policy Alerts takes a client-focused hands-on approach and works hard to provide our customers with helpful insights and actionable analytics over raw data. We understand what our clients need and we are dedicated to making sure we provide timely, accurate and always up-to-date reports that can be used to implement and support a successful reimbursement strategy.

Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.

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