Effective 2026-03-15 Cigna designates specific adalimumab products (including listed NDC ranges for adalimumab-bwwd, adalimumab-ryvk, Amjevita, Humira, and Hyrimoz) as Non‑Covered for Employer and Individual plans. Crohn’s disease initial‑therapy criteria were narrowed by removing prior systemic corticosteroid trial/contraindication, the requirement/option of a conventional systemic therapy trial, fistulizing disease and prior ileocolonic resection as approval routes. Initial approvals for adalimumab are age‑based (Crohn’s: ≥6 years; UC: ≥5 years) for 6 months when prescribed by or in consultation with a gastroenterologist; established patients (≥6 months on therapy) may receive 1‑year renewals with documented objective improvement or symptom improvement. The policy cites recent ACG/AGA guidance supporting upfront use of advanced therapies/TNF inhibitors and clarifies limited evidence for adalimumab efficacy in UC after prior TNFi failure.
March 15, 2026 Revision: Non‑Covered Adalimumab Products and Crohn's Disease Criteria
Summary of Revisions Effective 2026-03-15
This revision (Annual Revision, 2 = 03/15/2026) documents two notable administrative and substantive updates. First, a note was added designating specific adalimumab NDCs/brands — adalimumab-bwwd, adalimumab-ryvk (NDCs starting with 51759), Amjevita (NDCs starting with 84612), Humira (NDCs starting with 83457), and Hyrimoz (NDCs starting with 83457) — as Non‑Covered products for Employer Plans and Individual. This is an explicit coverage status change for those listed products.
Second, the Crohn's disease initial therapy criteria were narrowed by removal of several previously listed options for approval. Specifically removed were: (a) prior trial or current use of systemic corticosteroids or corticosteroid contraindication as an initial approval route; (b) requirement/options relating to a trial of one conventional systemic therapy for Crohn's disease (and its associated note); (c) presence of enterocutaneous (perianal or abdominal) or rectovaginal fistulas as an approval route; and (d) prior ileocolonic resection (to reduce recurrence risk). These removals reflect a change in the documented initial-therapy pathways for Crohn's disease within the policy.
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