Cigna updated and consolidated infliximab dermatology coverage (effective 2026-03-15) within Drug Coverage Policy IP0660, specifying FDA‑based dosing, approval durations, and indication-specific criteria for plaque psoriasis, hidradenitis suppurativa, and pyoderma gangrenosum (also covering related uses such as immunotherapy toxicities and sarcoidosis). Initial approvals are time‑limited (typically 3 months for psoriasis and HS; 4 months for pyoderma gangrenosum) with requirements for prior therapies or contraindications and dermatologist involvement. Continuation approvals for patients already on an infliximab product allow 1‑year coverage when the patient has been on therapy for the specified minimum (≥3 months for psoriasis/HS; ≥4 months for pyoderma gangrenosum) and shows objective and symptom‑based clinical improvement. Dosing is standardized: initial regimens up to 5 mg/kg with maintenance no more often than every 8 weeks, and established patients may receive up to 10 mg/kg no more often than every 4 weeks.
March 15, 2026 Revision: Consolidated `infliximab` Dermatology Criteria (`IP0660`)
This revision (effective 2026-03-15) consolidates and specifies infliximab coverage across dermatology and related inflammatory skin conditions within Cigna's Drug Coverage Policy IP0660. The policy details FDA‑approved indications (including dosing regimens for initial and maintenance therapy) and explicit coverage criteria for dermatologic uses such as plaque psoriasis, hidradenitis suppurativa, and pyoderma gangrenosum, as well as related indications like immunotherapy‑related toxicities and sarcoidosis.
The document clarifies duration approvals for initial therapy (commonly 3–4 months depending on indication) versus continuation (1 year) when patients are established on therapy and have demonstrated benefit by defined objective or symptom-based measures. Dosing limits are standardized across indications: initial standard dosing up to 5 mg/kg with maintenance no more frequently than every 8 weeks, and an allowance for up to 10 mg/kg no more frequently than every 4 weeks for patients already receiving an infliximab product.
`Plaque Psoriasis`: Specific Step and Response Criteria, Durations, and Dosing
Plaque psoriasis coverage is divided into initial therapy and continuation for patients currently receiving therapy. For initial therapy, approval for 3 months is available for adults (≥ 18 years) who meet all criteria: age, prior use of at least one traditional systemic agent for ≥ 3 months (unless intolerant), or a documented contraindication to methotrexate, and prescription by or in consultation with a dermatologist. An exception is permitted if the patient previously tried a biologic (other than the requested agent), /, or had prior intolerance.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.