CurrentCignaPolicy IP0662

Omvoh Intravenous Prior Authorization Policy

Appendix listing biologic, subcutaneous, intravenous, and oral targeted therapies with mechanisms and example indications; supplements a Cigna gastroenterology coverage policy for inflammatory and immune-mediated conditions.

Policy Summary

PayerCigna

PolicyOmvoh Intravenous Prior Authorization Policy

Policy CodePolicy IP0662

Change TypeInformational appendix (no coverage changes)

Effective Date09/01/2025

Next Review DateN/A

Key ActionRefer to this appendix as a reference for biologic and targeted therapies and consult prescribing information for FDA-approved indications.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~25therapeutic agents listed (approximate)

multipleformulations included (SC, IV, oral)

examplesindications include CD and UC among others

Coverage Criteria (Appendix Scope)

This appendix is not an all-inclusive list of indications for the therapies shown. Providers should consult the prescribing information for each agent to confirm FDA‑approved indications and specific labeled uses. The appendix is intended as an informational catalog of agents, formulations, and example indications rather than as definitive coverage criteria.

Provider Actions and Authorization Notes

Prior Authorization

Prior authorization not specified in appendix

Prior authorization not specified in appendix — The appendix content lists drug agents, mechanisms, and example indications but does not state any prior authorization requirements for the listed agents.

Appendix lists agents, mechanisms, and example indications only; no prior authorization rules provided.

Step Therapy

No step therapy requirements specified

Policy Summary

PayerCigna

PolicyOmvoh Intravenous Prior Authorization Policy

Policy CodePolicy IP0662

Change TypeInformational appendix (no coverage changes)

Effective Date09/01/2025

Next Review DateN/A

Key ActionRefer to this appendix as a reference for biologic and targeted therapies and consult prescribing information for FDA-approved indications.

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.

No step therapy requirements specified — The appendix does not include any step therapy or failure-to-respond sequencing requirements for the agents shown.

No step therapy or required trial-of-therapy sequences are stated in the appendix.

Documentation Required

No documentation requirements specified

No documentation requirements specified — The appendix does not provide required clinical documentation, chart notes, or specific supporting information needed for coverage decisions.

No required supporting documentation (e.g., prior treatment history, labs, imaging, symptom scores) is specified in the appendix.

Denial Risk

No explicit authorization or denial criteria

No explicit authorization or denial criteria present — The appendix content is limited to drug names, mechanisms, and example indications and does not include authorization criteria, medical necessity criteria, or denial conditions.

Authorization or denial criteria (medical necessity, exclusions, or coverage thresholds) are not stated in the appendix.

Background and Purpose

This appendix catalogs biologic and targeted oral therapies used across immune‑mediated conditions such as psoriasis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, and related disorders. It summarizes primary mechanisms of action referenced in the appendix (for example, IL pathway antagonists, PDE4 inhibitors, JAK/TYK2 inhibitors, S1P modulators, and TNF inhibitors) and lists formulations noted in the appendix (for example, SC and IV). The appendix is meant as a non‑exhaustive reference to support clinical review and decision making.

Terminology and Abbreviations

SC — Subcutaneous

SCSubcutaneous

Usage noteAbbreviation appears in appendix as a formulation descriptor for listed agents

ContextUsed alongside other abbreviations (e.g., IV, IL) in the appendix legend

IV — Intravenous

IVIntravenous

Usage noteAbbreviation appears in appendix as a formulation descriptor for listed agents

ContextUsed alongside other abbreviations (e.g., SC, IL) in the appendix legend

IL — Interleukin

ILInterleukin

Usage noteAbbreviation provided in appendix as part of mechanism/agent descriptions

ContextAppears in the appendix legend with other immunologic abbreviations (e.g., TNF, JAK)