Topical Vitamin D Analogs Step Therapy Policy
Defines Cigna's step therapy requirements for coverage of topical vitamin D analog products for plaque psoriasis across applicable commercial health benefit plans administered by Cigna companies.
No material clinical or coverage changes in this revision.
Coverage Criteria
Step Therapy Criteria
Covered when the following step therapy requirements are met
Approvals are for 1 year
These products may be approved without prior Step 1 trial for patients under 18
Topical vitamin D analog products are covered when the step therapy requirements are met. Specifically, a Step 1 product (generic calcipotriene cream, ointment, or solution) must be tried prior to approval of a Step 2 product. All approvals are provided for 1 year when the step therapy criteria are satisfied. Any product use that does not meet these step therapy criteria is considered not medically necessary unless an exception applies.
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