Cardiology - Ranolazine Products Step Therapy Policy
Defines step therapy coverage requirements for ranolazine products (generic ranolazine ER tablets, Ranexa, and Aspruzyo Sprinkle) for Cigna-administered health benefit plans and the conditions for approval.
No material clinical or coverage changes in this revision.
Coverage Criteria for Ranolazine Products
Initial Step Therapy and Aspruzyo Exception
Covered when ALL of the following are met
Approvals are provided for 1 year
If neither A nor B applies, standard Step 2 approval requires prior trial of one Step 1 product
This program requires adherence to the defined Step Therapy sequence for ranolazine products. The policy is designed to encourage use of a Step 1 product (generic ranolazine extended‑release tablets) before use of any Step 2 product. Per the policy statement, any use not meeting the step therapy criteria is considered not medically necessary and is not eligible for coverage except where the specific step criteria or exceptions apply.
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