CurrentCignaPolicy N/A

Dermatology - Anzupgo Prior Authorization Policy

Customize your policy alerts

Sign up for all Cigna policy alerts

Know when Cigna releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

This policy governs prior authorization and medical-necessity coverage for Anzupgo (delgocitinib 2% cream) under Cigna prescription benefits. It applies to patients seeking treatment for moderate to severe chronic hand eczema and establishes clinical, specialist-prescribing, and concurrent-therapy requirements.

Policy Summary

PayerCigna

PolicyDermatology - Anzupgo Prior Authorization Policy

Policy CodePolicy N/A

Change TypeAnnual reviewno criteria changes

Effective DateAug 5, 2026

Last ReviewAug 5, 2026

Next Review DateN/A

Key ActionObtain prior authorization and document that the patient meets all chronic hand eczema criteria before prescribing Anzupgo.

SourceLink

POLICY UPDATE CHANGES

Generics for Xeljanz and Xeljanz XR were added to the appendix examples of other JAK inhibitors.

4 monthsInitial approval duration

≥18 yearsMinimum patient age

>3 months or ≥2 recurrencesDisease duration or recurrence

28 daysTopical corticosteroid trial

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentCignaPolicy N/A

Dermatology - Anzupgo Prior Authorization Policy

Customize your policy alerts

Sign up for all Cigna policy alerts

Know when Cigna releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerCigna

PolicyDermatology - Anzupgo Prior Authorization Policy

Policy CodePolicy N/A

Change TypeAnnual reviewno criteria changes

Effective DateAug 5, 2026

Last ReviewAug 5, 2026

Next Review DateN/A

Key ActionObtain prior authorization and document that the patient meets all chronic hand eczema criteria before prescribing Anzupgo.

SourceLink

POLICY UPDATE CHANGES

Generics for Xeljanz and Xeljanz XR were added to the appendix examples of other JAK inhibitors.

4 monthsInitial approval duration

≥18 yearsMinimum patient age

>3 months or ≥2 recurrencesDisease duration or recurrence

28 daysTopical corticosteroid trial

2% creamStrength and formulation

Medical Necessity and Concurrent-Use Criteria

Initial therapy for chronic hand eczema

Covered as medically necessary for the FDA-approved indication when ALL criteria A through E are met.

Initial therapy: chronic hand eczema

A. Age: The patient is at least 18 years of age.≥18 years
B. Disease chronicity: The patient's hand eczema 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 at least 2 recurrences in 1 year
C. Disease severity: According to the prescriber, the patient has moderate to severe chronic hand eczema.Moderate to severe
D. Prior topical corticosteroid therapy
- i. Corticosteroid potency: The patient has tried at least one medium-, medium-high-, high-, and/or superhigh-potency prescription topical corticosteroid.At least 1 qualifying prescription topical corticosteroid
- ii. Treatment duration: The topical corticosteroid was applied daily for at least 28 consecutive days.≥28 consecutive days
- iii. Inadequate efficacy: According to the prescriber, inadequate efficacy was demonstrated with the topical corticosteroid therapy.Inadequate efficacy
E. Specialist involvement: The medication is prescribed by or in consultation with an allergist, immunologist, or dermatologist.Specialist prescribing or consultation

Concurrent-use exclusions

Not medically necessary for the following concurrent uses.

Concurrent therapy exclusions

Other JAK inhibitor: Concurrent use with another JAK inhibitor.No concurrent JAK inhibitor
Potent immunosuppressant: Concurrent use with a potent immunosuppressant.No concurrent potent immunosuppressant

Concurrent use of Anzupgo with another JAK inhibitor is not recommended and is considered not medically necessary.

Concurrent use of Anzupgo with a potent immunosuppressant is not recommended and is considered not medically necessary.

Anzupgo is considered not medically necessary for uses outside the covered FDA-approved indication or for other uses without supportive evidence, including unapproved concurrent therapies.

Authorization, Documentation, and Billing Requirements

Prior Authorization

Prescription-Benefit Prior Authorization

Prior authorization is recommended for prescription-benefit coverage of Anzupgo cream. When authorized, the initial approval duration is 4 months (1 month equals 30 days).

Prior Authorization

Specialist Prescriber Required

Because Anzupgo requires specialized evaluation, diagnosis, and monitoring, it must be prescribed by or in consultation with a physician who specializes in the condition being treated.

For chronic hand eczema, the prescriber must be or consult with an allergist, immunologist, or dermatologist.

Step Therapy

Prior Topical Corticosteroid Trial

Document an adequate trial of prescription topical corticosteroid therapy before requesting Anzupgo.

Therapy Overview

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

Key Terms

Anzupgo

DefinitionA topical Janus kinase (JAK) inhibitor.

IndicationUsed for the topical treatment of moderate to severe chronic hand eczema.

対象 populationAdults aged 18 years and older.

Inadequate response

DefinitionFailure to maintain clear or almost clear skin despite daily topical corticosteroid application.

Required treatment periodAt least 28 days of daily topical corticosteroid application.

Maximum duration alternativeThe maximum duration recommended by the product prescribing information may apply when it is shorter than 28 days.

Policy Summary

PayerCigna

PolicyDermatology - Anzupgo Prior Authorization Policy

Policy CodePolicy N/A

Change TypeAnnual reviewno criteria changes

Effective DateAug 5, 2026

Last ReviewAug 5, 2026

Next Review DateN/A

Key ActionObtain prior authorization and document that the patient meets all chronic hand eczema criteria before prescribing Anzupgo.

SourceLink

On This Page

The patient must have tried at least one medium-, medium-high-, high-, and/or superhigh-potency prescription topical corticosteroid.
The corticosteroid must have been applied daily for at least 28 consecutive days.
The prescriber must document inadequate efficacy with the topical corticosteroid therapy.

Documentation Required

Document Clinical Eligibility

Submit documentation supporting every clinical eligibility element for chronic hand eczema coverage.

Patient is 18 years of age or older.
Diagnosis is chronic hand eczema.
The prescriber considers the condition moderate to severe.
Hand eczema has been present for more than 3 months, or has returned at least twice in 1 year after initial presentation and subsequent clearance.
Prior topical corticosteroid treatment, duration, and inadequate efficacy are documented.
The medication is prescribed by or in consultation with an appropriate specialist.

Unsupported block type: documentation

Denial Risk

Failure to Meet Approval Criteria

Approval is at risk if the patient does not meet all applicable criteria for the FDA-approved indication.

Patient is younger than 18 years.
The diagnosis is not chronic hand eczema.
The condition is not moderate to severe as documented by the prescriber.
Disease duration or recurrence requirements are not met.
Required prior treatment or inadequate response is not documented.
Specialist prescribing or consultation is not documented.

Denial Risk

Prohibited Concurrent Therapy

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

Concurrent use with another topical or systemic JAK inhibitor is not recommended and may result in denial.
Concurrent use with a potent immunosuppressant is not recommended and may result in denial.
Safety and efficacy of these combinations have not been established.

Billing Rule

Covered Codes Required

Claims must include the most appropriate applicable covered diagnosis and/or procedure codes effective on the submission date. Claims submitted without covered code(s) may be denied as not covered.

Use covered diagnosis and/or procedure code(s) applicable to the service and condition.
Services billed for conditions or diagnoses not covered under the policy are not reimbursable.

JAK inhibitor

DefinitionA medication class that includes agents affecting Janus kinase pathways.

Anzupgo classificationAnzupgo is a topical JAK inhibitor.

Concurrent-use implicationUse of Anzupgo in combination with another JAK inhibitor is not recommended and is considered not medically necessary.