Cigna updated IP0660 to clarify infliximab coverage criteria for sarcoidosis and immunotherapy-related toxicities, separating initial-therapy from continuation requirements and formalizing approval durations. For sarcoidosis, initial approval (age ≥18) requires prior corticosteroid and at least one immunosuppressant trial and may be approved for 3 months; continued therapy requires ≥3 months on infliximab, objective organ-dependent benefit and symptomatic improvement for 1-year approval. For certain dermatologic immunotherapy toxicities, continuation requires ≥4 months on therapy, objective lesion improvement and symptom relief for 1-year approval. Dosing limits are specified: induction up to 5 mg/kg with maintenance every ≥8 weeks for initiation, and up to 10 mg/kg every ≥4 weeks permitted for established therapy.
March 2026 Revision: Clarified Infliximab Continuation Criteria
Summary of Changes in This Revision
This revision of Cigna's drug coverage policy IP0660 for MDC 04 Pulmonology clarifies and consolidates the explicit coverage criteria for infliximab use in sarcoidosis and immunotherapy-related toxicities. The document distinguishes initial therapy criteria from continuation (currently receiving) criteria, and specifies the required duration of prior therapy and measures of response for continued approval.
Notably, the policy sets distinct minimum established-on-therapy durations: 4 months for certain immunotherapy-related dermatologic indications and 3 months for sarcoidosis when assessing ongoing therapy. The dosing tables and the approval periods for each indication (e.g., 3 months initial approval for sarcoidosis vs. 1 year for established therapy) are reiterated and formalized in the current text.
Sarcoidosis: Initial and Continued Coverage Requirements
Specific Approval Criteria for infliximab in Sarcoidosis
For sarcoidosis, the policy provides two pathways: Initial Therapy (A) and Continued Therapy (B). Initial therapy may be approved for 3 months if the patient is over 18, has tried at least one corticosteroid (examples: prednisone, methylprednisolone), and has tried at least one immunosuppressive medication (examples: methotrexate, azathioprine, leflunomide, mycophenolate mofetil, hydroxychloroquine, chloroquine). Additionally, the medication must be prescribed by or in consultation with a pulmonologist, ophthalmologist, cardiologist, neurologist, or dermatologist.
For patients currently receiving an infliximab product, continued approval is granted for 1 year if the patient has been established on therapy for at least 3 months, has shown benefit by at least one objective measure (organ-dependent measures such as lung function, serum markers, imaging, or symptom/rash improvement), and has experienced symptomatic improvement (examples: decreased cough, fatigue, pain, palpitations, neurologic symptoms, or shortness of breath). These elements are required for ongoing coverage under criterion B.
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