CurrentCignaPolicy IP0759

Anzupgo

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This policy governs prior authorization and medical-necessity coverage for Anzupgo (delgocitinib 2% cream) for adults with moderate to severe chronic hand eczema. It applies to health benefit plans administered by Cigna, subject to the member's benefit plan, applicable law, and individual clinical review.

Policy Summary

PayerCigna

PolicyAnzupgo

Policy CodePolicy IP0759

Change TypeNo material change

Effective DateSeptember 15, 2026

Last ReviewSep 3, 2026

Next Review DateN/A

Key ActionObtain prior authorization and document specialist prescribing or consultation before submitting Anzupgo for coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4 moInitial approval duration

≥18Minimum patient age

>3 mo or ≥2/yrChronic eczema history

≥28 daysTopical steroid trial

2Noncovered concurrent-use categories

Coverage Criteria

FDA-approved indication: chronic hand eczema

Approve for 4 months when all of the following are met:

All coverage criteria

Patient and disease requirements
- Patient is at least 18 years of age.≥18 years
- Patient has hand eczema that has been present for more than 3 months or has returned at least twice in a year after its initial presentation and subsequent clearance.>3 months or ≥2 recurrences in a year
- According to the prescriber, the patient has moderate to severe chronic hand eczema.

Policy Summary

PayerCigna

PolicyAnzupgo

Policy CodePolicy IP0759

Change TypeNo material change

Effective DateSeptember 15, 2026

Last ReviewSep 3, 2026

Next Review DateN/A

Key ActionObtain prior authorization and document specialist prescribing or consultation before submitting Anzupgo for coverage.

SourceLink

On This Page

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CurrentCignaPolicy IP0759

Anzupgo

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Policy Summary

PayerCigna

PolicyAnzupgo

Policy CodePolicy IP0759

Change TypeNo material change

Effective DateSeptember 15, 2026

Last ReviewSep 3, 2026

Next Review DateN/A

Key ActionObtain prior authorization and document specialist prescribing or consultation before submitting Anzupgo for coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4 moInitial approval duration

≥18Minimum patient age

>3 mo or ≥2/yrChronic eczema history

≥28 daysTopical steroid trial

2Noncovered concurrent-use categories

Coverage Criteria

FDA-approved indication: chronic hand eczema

Approve for 4 months when all of the following are met:

All coverage criteria

Patient and disease requirements
- Patient is at least 18 years of age.≥18 years
- Patient has hand eczema that has been present for more than 3 months or has returned at least twice in a year after its initial presentation and subsequent clearance.>3 months or ≥2 recurrences in a year
- According to the prescriber, the patient has moderate to severe chronic hand eczema.

Policy Summary

PayerCigna

PolicyAnzupgo

Policy CodePolicy IP0759

Change TypeNo material change

Effective DateSeptember 15, 2026

Last ReviewSep 3, 2026

Next Review DateN/A

Key ActionObtain prior authorization and document specialist prescribing or consultation before submitting Anzupgo for coverage.

SourceLink

On This Page

Inadequate topical corticosteroid response

Patient has tried at least one medium-, medium-high-, high-, and/or super-high-potency prescription topical corticosteroid.
The topical corticosteroid was applied daily for at least 28 consecutive days.≥28 consecutive days
According to the prescriber, inadequate efficacy was demonstrated with this topical corticosteroid therapy.

Conditions not covered

Use is considered not medically necessary when either of the following applies:

Noncovered use

Anzupgo is used in combination with another JAK inhibitor, including another topical or systemic JAK inhibitor.
Concurrent use is not recommended; safety and efficacy of the combination are unknown.
Anzupgo is used in combination with a potent immunosuppressant.
Concurrent use is not recommended; safety and efficacy of the combination are unknown.

Concurrent use of Anzupgo with another JAK inhibitor is not recommended, including combination with another topical or systemic JAK inhibitor. Safety and efficacy of these combinations are unknown.

Concurrent use of Anzupgo with a potent immunosuppressant is not recommended. Safety and efficacy of this combination are unknown.

Anzupgo is considered not medically necessary for any use other than the covered indication of moderate to severe chronic hand eczema in adults. This includes concurrent use with another JAK inhibitor or a potent immunosuppressant.

Clinical Coding Requirements

Minimum age

Minimum ageAt least 18 years of age

Eligible populationAdults with chronic hand eczema

Approval requirementThe patient must meet the minimum-age criterion for coverage approval

Chronicity or recurrence

DurationHand eczema present for more than 3 months

RecurrenceHand eczema returned at least twice in a year

Recurrence historyRecurrences must follow the initial presentation and subsequent clearance

Topical corticosteroid trial

Medication typeAt least one prescription topical corticosteroid must have been tried

Application frequencyApply the topical corticosteroid daily

Minimum durationApply for at least 28 consecutive days

Provider and Authorization Actions

Prior Authorization

Prior Authorization Required

Prior authorization is required for benefit coverage of Anzupgo cream. Approval requires the medication to be prescribed by or in consultation with a physician who specializes in the condition being treated.

Prior Authorization

Initial Approval: 4 Months

Initial approval is available for 4 months when all applicable chronic hand eczema criteria are met, including the required age, disease history, severity, topical corticosteroid trial, inadequate response, and specialist involvement.

Patient is 18 years of age or older.
Hand eczema has been present for more than 3 months, or has returned at least twice in 1 year after initial presentation and clearance.
Prescriber documents moderate to severe chronic hand eczema.
Patient meets the required prescription topical corticosteroid trial and demonstrates inadequate efficacy.
An allergist, immunologist, or dermatologist prescribes or is consulted.

Step Therapy

Required Topical Corticosteroid Trial

Before initial approval, the patient must have tried a qualifying prescription topical corticosteroid with inadequate efficacy.

At least one medium-, medium-high-, high-, and/or super-high-potency prescription topical corticosteroid.
Applied daily for at least 28 consecutive days.
Prescriber documents that the topical corticosteroid therapy provided inadequate efficacy.

Documentation Required

Initial Authorization Documentation

Document all clinical information supporting the initial authorization request.

Patient age: 18 years or older.
Hand eczema duration of more than 3 months, or recurrence at least twice in 1 year after initial presentation and subsequent clearance.
Prescriber assessment that the condition is moderate to severe chronic hand eczema.
Qualifying prescription topical corticosteroid, potency, daily use for at least 28 consecutive days, and inadequate efficacy.
Name and role of the prescribing or consulting allergist, immunologist, or dermatologist.

Documentation Required

Specialist Involvement Required

Because of the specialized evaluation, diagnosis, and monitoring required, Anzupgo must be prescribed by or used in consultation with an appropriate specialist.

Acceptable specialist: allergist, immunologist, or dermatologist.
Document the specialist prescriber or consultation in the authorization request.

Documentation Required

Concurrent-Medication Review

Review the medication list before authorization and confirm that the patient is not using another JAK inhibitor or a potent immunosuppressant with Anzupgo.

No concurrent topical or systemic JAK inhibitor.
No concurrent potent immunosuppressant.

Denial Risk

Failure to Meet Initial-Therapy Criteria

Deny or do not approve initial therapy when the patient fails any required initial criterion.

Patient is younger than 18 years.
Hand eczema has not been present for more than 3 months and has not returned at least twice in 1 year after initial presentation and subsequent clearance.
Condition is not documented as moderate to severe chronic hand eczema.
Required qualifying topical corticosteroid trial, duration, or inadequate-efficacy documentation is absent.
Prescribing or consultation by an allergist, immunologist, or dermatologist is absent.

Denial Risk

Prohibited Concurrent Therapy

Anzupgo used in combination with another JAK inhibitor or a potent immunosuppressant is considered not medically necessary.

Do not approve concurrent use with other topical or systemic JAK inhibitors.
Do not approve concurrent use with potent immunosuppressants; safety and efficacy of these combinations are unknown.

Billing Rule

Authorization or Coding Failure

Claims may be denied when the submission does not include applicable covered codes or is billed for a diagnosis or condition not covered by the policy.

Use the most appropriate codes in effect on the submission date.
Claims submitted without applicable covered code(s) may be denied as not covered.
Reimbursement is not allowed for services billed for diagnoses or conditions not covered under the policy.

Background

Anzupgo (delgocitinib 2% cream) is a Janus kinase inhibitor for the topical treatment of moderate to severe chronic hand eczema in adults who have had an inadequate response to topical corticosteroids or for whom topical corticosteroids are not advisable.

Definitions

JAK

AbbreviationJAK

Full termJanus kinase

DefinitionJAK means Janus kinase

Inadequate response

Clinical outcomeFailure to maintain clear or almost clear skin

Required treatmentDespite daily application of a topical corticosteroid

Treatment durationAfter at least 28 days, or the maximum duration recommended by the product prescribing information, whichever is shorter