CurrentCignaPolicy CNF161

Topical Corticosteroids – Flurandrenolide Drug Quantity Management Policy – Per Days - (CNF161)

Defines quantity limits and medical necessity exceptions for topical flurandrenolide products (cream, ointment, lotion, various strengths) for Cigna-administered health benefit plans, including retail and home delivery maximums and criteria for approving quantities above limits. Approvals are for 1 year.

Policy Summary

PayerCigna

PolicyTopical Corticosteroids – Flurandrenolide Drug Quantity Management Policy – Per Days - (CNF161)

Policy CodePolicy CNF161

Change TypeAnnual revisionremoval of Nolix brand entries (03/11/2026)

Effective Date

Next Review Date

Key ActionSubmit request demonstrating FDA-approved indication and that patient meets product-specific exception (treats >8% BSA or needs >2 applications/day); approvals provided for 1 year.

SourceLink

POLICY UPDATE CHANGES

Annual Revision with no criteria changes reported for 03/28/2024 and 03/03/2025.

Annual Revision 03/11/2026: Brand Nolix cream and lotion were removed from the policy (obsolete).

120 gStandard retail max per 30 days

360 gStandard home delivery max per 90 days

240 g / 720 gCordran exception retail/home max

180 g / 540 gFlurandrenolide cream/ointment exception

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240 mL / 720 mLFlurandrenolide lotion exception

Coverage Summary

This Drug Quantity Management program applies to topical flurandrenolide products (cream, ointment, lotion) for Cigna-administered health benefit plans and defines standard retail and home delivery quantity limits and medical necessity exceptions. It is intended to prevent stockpiling, misuse, and overuse; if the quantity rule is not met at point of service, coverage is determined by the stated criteria. Approvals granted under the program are provided for 1 year in duration. The policy reflects coverage as a mixed stance with specified standard maximums (retail = 120 g/mL per 30 days; home delivery = 360 g/mL per 90 days) and product-specific exception pathways to approve larger quantities.

General Policy & Exception Criteria — Initial Approval

General Policy Statement / Approval Duration

This Drug Quantity Management program prevents stockpiling, misuse, and/or overuse. If rule not met at point of service, coverage determined by criteria below.

ALL of the following

General requirements: Requested medication is an FDA-approved indication for flurandrenolide
Product-specific conditions: Approval of exceptions when one of the product-specific conditions below is met
Approval duration: All approvals are provided for 1 year in duration

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Exceptions to Quantity Limits — Cordran (flurandrenolide 0.025% cream)

Approve additional quantities when the patient is using the product for an FDA-approved indication AND meets one of the following:

ANY of the following

Exceptional clinical need: Patient needs to treat greater than 8% of body surface area> 8% BSA
Approve requested quantity up to specified max
Exceptional clinical need: Patient needs to administer medication more frequently than two times a day> two times daily
Approve requested quantity up to specified max

Approval limits

Exceptions to Quantity Limits — Flurandrenolide 0.05% cream and 0.05% ointment

Approve additional quantities when the patient is using the product for an FDA-approved indication AND meets one of the following:

ANY of the following

Exceptional clinical need: Patient needs to treat greater than 8% of body surface area> 8% BSA
Exceptional clinical need: Patient needs to administer medication more frequently than two times a day> two times daily

Approval limits

Retail max (exception): Retail maximum not to exceed 180 grams per 30 days

Exceptions to Quantity Limits — Flurandrenolide 0.05% lotion

Approve additional quantities when the patient is using the product for an FDA-approved indication AND meets one of the following:

ANY of the following

Exceptional clinical need: Patient needs to treat greater than 8% of body surface area> 8% BSA
Exceptional clinical need: Patient needs to administer medication more frequently than two times a day> two times daily

Approval limits

Retail max (exception): Retail maximum not to exceed 240 mL per 30 days

Exclusions

Situations where additional quantities are not recommended

Exclusions: No overrides recommended for use in compounded formulations

Any other exception is considered not medically necessary

Products / Package Sizes (Referenced Codes)

Products / Package sizes referencedmixed

Cordran 0.025% cream	Package size = 120 gram tube; retail max per 30 days = 120 grams; home delivery max per 90 days = 360 grams (brand discontinued)
Flurandrenolide 0.05% cream	Package sizes = 60 gram tube, 120 gram tube; retail max per 30 days = 120 grams; home delivery max per 90 days = 360 grams
Flurandrenolide 0.05% ointment	Package size = 60 gram tube; retail max per 30 days = 120 grams; home delivery max per 90 days = 360 grams
Flurandrenolide 0.05% lotion	Package sizes referenced: 60 gram tube = 120 mL bottle, 120 grams = 120 mL, 360 grams = 360 mL; retail max per 30 days = 120 mL; home delivery max per 90 days = 360 mL

Provider Actions & Billing Rules

Prior Authorization

Request exceptions for quantities above limits

Submit a prior authorization request demonstrating the medication is being used for an FDA‑approved indication and that the patient meets a product-specific exception (treats >8% body surface area or requires administration more than two times daily). All approvals are provided for 1 year in duration.

Documentation Required

Document BSA or frequency justification

Document the percent of body surface area being treated (eg, via FTU/BSA estimation) or note the increased frequency of administration to justify requested quantities above the standard limit.

Background & Definitions

Flurandrenolide topical formulations are indicated for the relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, including moderate to severe plaque psoriasis. Dosing is commonly guided by the fingertip unit (FTU) method: one FTU ≈ 0.5 g, which treats approximately 2% BSA, so 1 g ≈ 4% BSA. Using the FTU methodology, the policy's quantity limits are set to provide enough product to cover approximately 8% BSA when applied twice daily for 30 days; limits are intended to prevent stockpiling, misuse, and overuse.

Clinical Evidence / References

Prescribing information references: Padagis 2022; Almirall 2013; INA Pharmaceutics/DPT Laboratories 2025

Revision History

03/28/2024Annual Revision

Annual Revision with no criteria changes reported.

03/03/2025Annual Revision

Annual Revision with no criteria changes reported.

03/11/2026Annual RevisionLatest

Policy Summary

PayerCigna

PolicyTopical Corticosteroids – Flurandrenolide Drug Quantity Management Policy – Per Days - (CNF161)

Policy CodePolicy CNF161

Change TypeAnnual revisionremoval of Nolix brand entries (03/11/2026)

Effective Date

Next Review Date

Key ActionSubmit request demonstrating FDA-approved indication and that patient meets product-specific exception (treats >8% BSA or needs >2 applications/day); approvals provided for 1 year.

SourceLink

On This Page

Retail max (exception): Retail maximum not to exceed 240 grams per 30 days240 grams per 30 days