CurrentCignaPolicy N/A

Topical Acne Products Step Therapy Policy

Defines Cigna's step therapy requirements for prescription topical acne products, specifying Step 1 preferred products and conditions under which Step 2 (brand or nonpreferred generics) will be approved for members covered by Cigna-administered benefit plans.

Policy Summary

PayerCigna

PolicyTopical Acne Products Step Therapy Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateMar 18, 2026

Key ActionDocument prior trial of one Step 1 product when requesting Step 2 coverage; approvals are granted for one year if criteria are met.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2therapy steps

1 yrauthorization duration

No criteria changesrecent revision

03/18/2026last review

Coverage Criteria

Step therapy criteria

Covered when ALL of the following are met

Step requirement: Patient has tried ONE Step 1 Producttrial of one Step 1 product

If met, approve a Step 2 product per policy (approvals are for 1 year)

Any Step 2 topical acne product is considered covered as medically necessary only when the Step Therapy criteria are met. Specifically, coverage for a Step 2 product requires documentation that the member has tried one Step 1 product as detailed in the policy. If the Step 1 trial requirement is satisfied, approve a Step 2 product per policy.

Any exception to the Step Therapy requirement is considered not medically necessary. In other words, requests for Step 2 products that do not meet the documented Step 1 trial requirement will be denied as not medically necessary.

Provider Actions and Authorization

Policy Summary

PayerCigna

PolicyTopical Acne Products Step Therapy Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateMar 18, 2026

Key ActionDocument prior trial of one Step 1 product when requesting Step 2 coverage; approvals are granted for one year if criteria are met.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Prior Authorization

Step 2 Prior Authorization

Approvals for Step 2 products are provided when step therapy criteria are met; all approvals are for 1 year.

All approvals are for 1 year in duration.

Step Therapy

Step Therapy Program Overview

This step therapy program requires use of a Step 1 product prior to a Step 2 product. If the Step Therapy rule is not met at the point of service, coverage for a Step 2 product may be denied. For the purpose of this policy, a topical acne product is defined as a gel, cream, lotion, solution/pledget, pad, foam, or ointment.

Step 1 examples: sodium sulfacetamide/sulfur 10%/5% emollient cream; generic prescription topical adapalene-, benzoyl peroxide-, clindamycin products (other than generic Clindagel and clindamycin phosphate 1% foam); dapsone-, erythromycin-, or sodium sulfacetamide-containing products.
Step 2 examples: Brand name topical acne products (Aklief, Amzeeq, Azelex, Aczone, Erygel, Klaron, Plexion brands, Acanya, Benzamycin, Cabtreo, Epiduo [brand], Twyneo, Ziana, Veltin), and certain generics listed in policy.
If the patient has tried one Step 1 product, approve a Step 2 product.

Documentation Required

Billing and Documentation Expectations

When billing, providers must submit claims using the covered diagnosis and/or procedure codes as outlined in the applicable Coverage Policy. Use the most appropriate codes as of the effective date of the submission. Claims submitted for services that are not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered.

Use the most appropriate diagnosis/procedure codes as of the submission date.
Reimbursement is not allowed when billed for conditions or diagnoses not covered under this Coverage Policy.
Claims lacking covered codes under the applicable Coverage Policy will be denied as not covered.

Denial Risk

Step Therapy Denial Trigger

Coverage for a Step 2 product may be denied at the point of service if the Step Therapy rule is not met.

Denial may occur at point of service when Step 1 product use is not documented or criteria not met.

Background

Topical agents commonly used to treat acne vulgaris include benzoyl peroxide, topical antibiotics such as clindamycin, dapsone, azelaic acid, sulfacetamide/sulfur, and topical retinoids (for example, adapalene and trifarotene). Product formulation (gel, cream, lotion, foam, or ointment) should be selected based on the agent’s characteristics and the patient’s skin type and tolerance.

Definitions

inv-09: Topical acne product — Definition

DefinitionA gel, cream, lotion, solution/pledget, pad, foam, or ointment used to treat acne.

Formulations includedGel, cream, lotion, solution/pledget, pad, foam, ointment.

Policy contextDefined for the Step Therapy program that requires use of a Step 1 product prior to Step 2 products.

Use in coverage determinationsThis definition is used to identify products subject to the topical acne step therapy criteria and prior authorization rules.