CurrentCignaPolicy N/A

Topical Vitamin D Analogs Step Therapy Policy

Defines Cigna's step therapy requirements for coverage of topical vitamin D analog products used to treat plaque psoriasis, and who is affected (members receiving these topical agents).

Policy Summary

PayerCigna

PolicyTopical Vitamin D Analogs Step Therapy Policy

Policy CodePolicy N/A

Change TypeOperational — material

Effective DateN/A

Next Review DateJan 28, 2026

Key ActionObtain documentation that the patient tried one Step 1 product before requesting approval for a Step 2 product; approvals are provided for 1 year.

SourceLink

POLICY UPDATE CHANGES

Generic calcipotriene-betamethasone dipropionate suspension and Taclonex suspension were added to Step 2 with an exception if the patient is < 18 years of age.

2therapy steps

1 yrapproval duration

<18pediatric exception

psoriasisindication

Coverage Criteria

Step Therapy Criteria

Covered when the Step Therapy criteria below are met.

Primary step therapy logic

Step 1 requirement: Patient has tried one Step 1 product (generic calcipotriene cream, generic calcipotriene ointment, or generic calcipotriene solution)1 product tried
If met, approve a Step 2 product
Pediatric exception: If patient is < 18 years of age, approve one of the specified Step 2 products without prior Step 1 trialage < 18 years
Allowed Step 2 products for <18: calcipotriene foam (authorized generic), generic calcipotriene-betamethasone dipropionate ointment, generic calcipotriene-betamethasone dipropionate suspension, Enstilar foam, Sorilux foam, Taclonex ointment, or Taclonex suspension

Policy Summary

PayerCigna

PolicyTopical Vitamin D Analogs Step Therapy Policy

Policy CodePolicy N/A

Change TypeOperational — material

Effective DateN/A

Next Review DateJan 28, 2026

Key ActionObtain documentation that the patient tried one Step 1 product before requesting approval for a Step 2 product; approvals are provided for 1 year.

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.

Covered Products and Codes

Covered topical vitamin D analog products (by product name)mixedCovered

Calcipotriene 0.005% foam - Trifluent Pharma (authorized generic)	Calcipotriene 0.005% foam - Trifluent Pharma (authorized generic)
Calcipotriene 0.005% ointment (generic only)	Calcipotriene 0.005% ointment (generic only)
Calcipotriene 0.005% solution (generic only)	Calcipotriene 0.005% solution (generic only)
Dovonex (calcipotriene cream 0.005% - LEO Pharma, generic)	Dovonex (calcipotriene cream 0.005% - LEO Pharma, generic)
Enstilar (calcipotriene 0.005% and betamethasone dipropionate 0.064% foam - LEO Pharma)	Enstilar (calcipotriene 0.005% and betamethasone dipropionate 0.064% foam - LEO Pharma)
Sorilux (calcipotriene foam 0.005% - Mayne Pharma, generic)	Sorilux (calcipotriene foam 0.005% - Mayne Pharma, generic)
Taclonex (calcipotriene 0.005% and betamethasone dipropionate 0.064% ointment and suspension - LEO Pharma, generic)	Taclonex (calcipotriene 0.005% and betamethasone dipropionate 0.064% ointment and suspension - LEO Pharma, generic)
Wynzora (calcipotriene 0.005% and betamethasone dipropionate 0.064% cream - MC2 Therapeutics)	Wynzora (calcipotriene 0.005% and betamethasone dipropionate 0.064% cream - MC2 Therapeutics)

Provider Actions and Authorization Rules

Denial Risk

Denial trigger for not meeting step therapy

If the Step Therapy rule is not met for a Step 2 Product at the point of service, coverage will be determined by the Step Therapy criteria. Denials may be issued when a required Step 1 product has not been tried prior to a Step 2 product unless clinical criteria for an exception are met.

Denial risk triggered at point of service when Step 1 product not tried
All approvals provided for 1 year

Step Therapy

Step therapy actions — required sequence and exceptions

Step 1 products must be tried before a Step 2 product will be approved. Specifically: try one Step 1 product (generic calcipotriene cream, ointment, or solution). If the patient has tried one Step 1 product, a Step 2 product may be approved. For patients < 18 years old, approve specific Step 2 products per criteria (calcipotriene foam [authorized generic], generic calcipotriene-betamethasone dipropionate ointment or suspension, Enstilar foam, Sorilux foam, Taclonex ointment or suspension). Approvals are for 1 year.

Step 1: generic calcipotriene cream, generic calcipotriene ointment, generic calcipotriene solution
Step 2: generic calcipotriene-betamethasone dipropionate ointment, generic calcipotriene-betamethasone dipropionate suspension, calcipotriene foam (authorized generic), Dovonex cream, Enstilar foam, Sorilux foam, Taclonex ointment, Taclonex suspension, Wynzora cream

Billing Rule

Billing and coding documentation

When submitting claims, providers must use the most appropriate diagnosis and procedure codes effective on the date of service. Claims for services not accompanied by covered codes under the applicable coverage policy will be denied as not covered. Ensure billing documentation supports that a Step 1 product was tried (medication name, dates of use, clinical notes) to substantiate medical necessity for a Step 2 product.

Use most appropriate codes as of the date of service
Include documentation of Step 1 product trial (drug name, dates, clinical rationale)

Definitions

Indication — plaque psoriasis

IndicationPlaque psoriasis (topical vitamin D analogs are indicated for treatment of plaque psoriasis)

Age-specific approvalsProducts have varying age indications (examples: Enstilar and Taclonex indicated for ≥12 years; some calcipotriene foams indicated for ≥4 years)

Anatomic site-specific approvalsSome formulations are indicated for scalp psoriasis (calcipotriene solution, Taclonex suspension/generic suspension for scalp)

Product examplesIncludes calcipotriene cream, ointment, solution; calcipotriene foam (authorized generic, Sorilux); combination calcipotriene–betamethasone products (Enstilar, Taclonex, Wynzora)

Calcipotriene-betamethasone products — combination topical therapies

DefinitionCalcipotriene–betamethasone products are combination topical therapies containing calcipotriene and betamethasone dipropionate for treatment of plaque psoriasis.

Age limits vary by formulationEnstilar and Taclonex formulations indicated for patients ≥12 years; Wynzora indicated for ≥18 years; some calcipotriene–betamethasone products (foams, ointment, suspension) have pediatric indications down to ≥4 years depending on product.

Formulation typesAvailable as foam, ointment, suspension, and cream formulations (examples: Enstilar foam, Taclonex ointment/suspension, Wynzora cream)

Scalp vs body indicationsSome combination suspensions/solutions are specifically indicated for scalp and body plaque psoriasis (e.g., Taclonex suspension for scalp and body in ≥12 years; generic suspension indications differ by age/site)

OpenPayer

Topical Vitamin D Analogs Step Therapy Policy

Coverage Criteria

Covered Products and Codes

Provider Actions and Authorization Rules

Background

Definitions