Hyperlipidemia - Omega-3 Fatty Acid Products
Cigna prior authorization policy for prescription coverage of omega-3 fatty acid products (Vascepa and generics/icosapent ethyl capsules) specifying clinical criteria for FDA‑approved and supported uses, duration of approval, preferred product rules for Individual and Family Plans, and exclusions.
Updated policy title to Hyperlipidemia - Omega-3 Fatty Acid Products and added examples of cardiovascular disease and risk factors; clarified indications distinguishing FDA‑approved vs supportive evidence.
Coverage Summary
This policy (Coverage Policy Number IP0051) describes Cigna prior authorization requirements for icosapent ethyl (Vascepa and bioequivalent generics). The policy stance is covered with criteria; approvals are granted for 1 year when specified clinical criteria are met. The scope covers Vascepa and generic icosapent ethyl capsules and specifies criteria for the FDA‑approved cardiovascular risk reduction indication, severe hypertriglyceridemia (TG ≥ 500 mg/dL), and other supportive hypertriglyceridemia uses (TG 150 mg/dL to < 500 mg/dL).