Somavert
Defines Cigna's prior authorization, medical necessity criteria, and coverage stance for Somavert (pegvisomant) for treatment of acromegaly; applies to providers seeking benefit coverage under Cigna-administered health plans.
Acromegaly documentation requirement was changed to require documentation that the individual has (or had) a pre-treatment (baseline) IGF-1 level above the upper limit of normal based on age and gender for the reporting laboratory.
Removed prior documentation requirements from Acromegaly criteria during annual review.
Coverage Criteria for Somavert (pegvisomant)
Initial therapy for Acromegaly
Somavert is considered medically necessary when ALL of the following are met; approve for 1 year if all met.
Baseline defined as prior to initiation of any somatostatin analog, dopamine agonist, or Somavert.
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