Effective March 15, 2026, Cigna now authorizes Tremfya IV induction for adults (≥18) with moderate to severe Crohn’s disease or ulcerative colitis using a three-dose 200 mg IV regimen at Weeks 0, 4, and 8, with subsequent transition to subcutaneous maintenance. Approved SC maintenance options after IV induction are 100 mg at Week 16 then every 8 weeks, or 200 mg at Week 12 then every 4 weeks, with guidance to use the lowest effective maintenance dose. A three‑dose SC induction (400 mg at Weeks 0, 4, and 8) is also acceptable and follows the same SC maintenance schedules. The policy aligns coverage with FDA indications, requires gastroenterologist involvement, and references 2024–2025 ACG/AGA guidance placing IL‑23 inhibitors among recommended advanced therapies for induction and maintenance.
March 2026 Revision: `Tremfya IV` Induction and Maintenance Clarified
Summary of changes in this revision
This revision (effective 2026-03-15) codifies intravenous (IV) induction dosing and post-induction maintenance strategy for Tremfya in both Crohn's disease (CD) and ulcerative colitis (UC). The policy explicitly lists the IV three-dose induction regimen of 200 mg at Weeks 0, 4, and 8 for adults with moderate to severe active disease, and ties the IV induction to specified subcutaneous (SC) maintenance dosing schedules.
The document also aligns the coverage statements with FDA-approved indications by specifying patient age (≥ 18 years) and that treatment be prescribed by or in consultation with a gastroenterologist. Additionally, guideline references (ACG, AGA) from 2024–2025 are incorporated to contextualize IL-23 inhibitors among other advanced therapies for CD and UC.
Covered Indications and Eligibility Criteria for `Tremfya IV`
Indications and patient eligibility for Tremfya IV
The policy covers Tremfya intravenous (IV) specifically for induction treatment of adult patients (≥ 18 years) with moderate to severe active Crohn's disease (CD) and ulcerative colitis (UC). Approval requires that the medication be used as induction therapy and be prescribed by or in consultation with a gastroenterologist, mirroring the FDA-approved indication language in the document.
For both CD and UC the policy states the same three-dose IV induction regimen (200 mg at Weeks 0, 4, and 8) as the approved dosing to be authorized under the policy.
Specified Dosing Regimens: `IV` Induction and `SC` Maintenance
Dosing pathways: IV induction linked to SC maintenance
The policy specifies a treatment sequence: a three-dose IV induction followed by SC maintenance. For IV induction, authorize 200 mg IV at Weeks 0, 4, and 8. After IV induction, the recommended SC maintenance options are either 100 mg SC at Week 16 then every 8 weeks, or 200 mg SC at Week 12 then every 4 weeks. The policy text emphasizes using the lowest effective maintenance dose to maintain therapeutic response.
The policy also notes an alternative induction route: a three-dose SC induction (400 mg at Weeks 0, 4, and 8) is acceptable, and maintenance after SC induction follows the same SC maintenance schedules as after IV induction.
Guideline Context: `Tremfya` Within Advanced Therapy Options
Placement among guideline-recommended advanced therapies
The policy cites recent specialty guidelines (ACG 2025, AGA 2024–2025) that recommend upfront use of advanced therapies for moderate to severe CD and UC rather than a strict step-up approach. Tremfya (an IL-23 inhibitor) is listed among other advanced therapies alongside TNF inhibitors, vedolizumab (Entyvio), IL-12/23 inhibitors, S1P receptor modulators, and JAK inhibitors for UC; for CD the policy names the same classes plus upadacitinib (Rinvoq).
This placement clarifies that Tremfya is considered within the class of viable advanced therapies for induction in moderate to severe disease per the cited guideline documents, and that therapies effective for induction are to be continued for maintenance according to those guideline statements.
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