Cigna revised its IP0652 pulmonology policy to define time-limited approval windows and prescriber/consultation requirements for adalimumab use in sarcoidosis. Initial therapy approvals are limited to 3 months for adults after documented trials of corticosteroids and at least one immunosuppressive agent, with prescribing or consultation by a pulmonologist, ophthalmologist, or dermatologist. Continuing therapy approvals require at least 3 months on therapy, documented objective improvement versus baseline plus symptomatic benefit, and are granted for up to 1 year. The policy aligns coverage with guideline recommendations supporting TNF inhibitors after failure of steroids and immunosuppressants and standardizes objective measures for ongoing benefit assessment.
March 15 2026 Revision: Adalimumab Criteria for Sarcoidosis
This revision is specific to Cigna's IP0652 policy within the Pulmonology MDC covering use of adalimumab products for sarcoidosis. The document adds or clarifies time-limited approval periods and prescriber/consultation requirements for both initial and continuing therapy for sarcoidosis. For initial therapy, the policy specifies a 3-month approval window when criteria are met. For continuing therapy, the policy specifies a 1-year approval window contingent on duration of prior therapy and documented clinical benefit.
The revision also standardizes objective-measure requirements and baseline comparison language for ongoing approvals. It differentiates initial-therapy pathways (short-term approval) from continuation pathways (longer-term approval) and clarifies which specialists may prescribe or consult (pulmonologist, ophthalmologist, or dermatologist).
Initial Therapy Criteria: 3-Month Approval for Sarcoidosis
The policy establishes two distinct approval pathways for sarcoidosis when using adalimumab products: Initial Therapy (A) and Continuing Therapy (B). Under Initial Therapy (A), approval is granted for 3 months if all listed criteria are met: patient age > 18 years, prior trial of at least one corticosteroid (example: prednisone), prior trial of at least one immunosuppressive medication (examples provided in policy), and the medication is prescribed by or in consultation with a pulmonologist, ophthalmologist, or dermatologist.
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