CurrentCignaPolicy IP0150

Oncology (Injectable) - Cosela

Defines prior authorization, coverage criteria, dosing, and coding for Cosela (trilaciclib) when used to decrease chemotherapy-induced myelosuppression in adults with extensive-stage small cell lung cancer (SCLC) for Cigna-administered plans.

Policy Summary

PayerCigna

PolicyOncology (Injectable) - Cosela

Policy CodePolicy IP0150

Change TypeMaterial revisions (name/dosing addedcycle 1 coadministration restriction added)

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and ensure Cosela is prescribed by or in consultation with an oncologist; approvals for the FDA indication are for 6 months.

SourceLink

POLICY UPDATE CHANGES

Policy name updated from 'Trilaciclib Injection' to 'Oncology (Injectable) - Cosela' and dosing information for small cell lung cancer was added.

Added criterion that during the first cycle of chemotherapy, Cosela will not be co-administered with a G-CSF or an ESA.

240 mg/m2recommended per-dose Cosela dosing

6 monthsinitial approval duration for FDA indication

J1448HCPCS code for trilaciclib

Adults ≥18age requirement

Coverage Criteria for Cosela (trilaciclib)

Cosela (trilaciclib) for any use other than the FDA‑approved indication described in this policy is considered not medically necessary.

Use of Cosela for indications other than the FDA‑approved extensive‑stage small cell lung cancer criteria listed above is considered not medically necessary.

Chemotherapy Regimens When Prophylactic Cosela Use Is Covered

Regimen	Coverage status	Notes
Platinum (carboplatin or cisplatin) + etoposide-containing regimens	Covered as prophylactic use to decrease the incidence of chemotherapy-induced myelosuppression when trilaciclib (Cosela) is administered prior to the indicated chemotherapy regimen for extensive-stage SCLC.	Approve one 240 mg/m2 IV dose for every day chemotherapy is given; prior authorization per policy required (initial approval for 6 months when all FDA-approved indication criteria are met).
Topotecan-containing regimens	Covered as prophylactic use to decrease the incidence of chemotherapy-induced myelosuppression when trilaciclib (Cosela) is administered prior to the indicated chemotherapy regimen for extensive-stage SCLC.	Approve one 240 mg/m2 IV dose for every day chemotherapy is given; during cycle 1 Cosela will not be coadministered with a G-CSF or an ESA per prescriber statement. Prior authorization per policy required.

Coding and Dosing Information

Covered HCPCS CodesHCPCSCovered

C9078	Injection, trilaciclib, 1 mg (Code deleted 09/30/2021)
J1448	Injection, trilaciclib, 1 mg

Policy Summary

PayerCigna

PolicyOncology (Injectable) - Cosela

Policy CodePolicy IP0150

Change TypeMaterial revisions (name/dosing addedcycle 1 coadministration restriction added)

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and ensure Cosela is prescribed by or in consultation with an oncologist; approvals for the FDA indication are for 6 months.

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, Prescriber Requirements, and Billing Guidance

Prior Authorization

Prior Authorization Required

Prior authorization is required for Cosela; approvals are provided for the durations noted in the policy (e.g., 6 months for the FDA‑approved extensive‑stage SCLC indication). For approvals expressed in months, 1 month = 30 days. Cosela must be prescribed by or in consultation with a physician who specializes in the condition being treated (oncologist for the SCLC indication).

Approvals: 6 months for FDA‑approved extensive‑stage SCLC when all criteria met
1 month = 30 days
Prescriber requirement: prescribed by or in consultation with an oncologist

Denial Risk

Coding and Prior Authorization Denial Risk

Claims submitted without covered diagnosis or procedure codes listed in this policy will be denied. Reimbursement is not allowed for services billed for conditions or diagnoses that are not covered under this Coverage Policy. When billing, providers must use the most appropriate codes as of the date of submission.

Claims lacking covered diagnosis/procedure codes will be denied
Use most appropriate codes as of the submission date

Step Therapy

No step therapy requirements are specified for Cosela in this policy.

Step therapy: none specified

Documentation Required

Prescriber and Approval Duration

Because of the specialized skills required for evaluation and monitoring, Cosela must be prescribed by or in consultation with a physician who specializes in the condition being treated. For the FDA‑approved extensive‑stage SCLC indication the medication must be prescribed by or in consultation with an oncologist. Approvals for the FDA indication are for 6 months when all criteria are met.

Prescriber: physician specializing in condition (oncologist for SCLC)
Approval duration for FDA‑approved extensive‑stage SCLC: 6 months

Background

Trilaciclib (Cosela) is administered prior to each day chemotherapy is given to decrease the incidence of chemotherapy‑induced myelosuppression in adults with extensive‑stage small cell lung cancer. The policy approves Cosela for 6 months when all FDA‑approved criteria are met, including age ≥ 18 years, extensive‑stage disease, use to reduce chemotherapy‑induced myelosuppression, receipt of an eligible regimen (either a platinum [carboplatin or cisplatin] plus etoposide regimen or a topotecan‑containing regimen), that during the first cycle Cosela will not be coadministered with a granulocyte‑colony stimulating factor (G‑CSF) or an erythropoiesis‑stimulating agent (ESA), and that the medication is prescribed by or in consultation with an oncologist. Dosing is 240 mg/m2 as an IV infusion for each day chemotherapy is given.

OpenPayer