CurrentCignaPolicy N/A

Sickle Cell Disease - L-glutamine Prior Authorization Policy

Prior authorization policy for coverage of L-glutamine oral powder (Endari and generic) for treatment of sickle cell disease in Cigna-administered benefit plans, specifying criteria, documentation and duration of approval.

Policy Summary

PayerCigna

PolicySickle Cell Disease - L-glutamine Prior Authorization Policy

Policy CodePolicy N/A

Change TypeRevisionAnnual reviews

Effective Date

Next Review Date

Key ActionPrior authorization is required for L-glutamine oral powder; approvals are provided for 1 year and documentation is required as noted in the criteria.

SourceLink

POLICY UPDATE CHANGES

Generic L-glutamine oral powder was added to the policy and policy name changed from 'Sickle Cell Disease - Endari PA' to 'Sickle Cell Disease - L-glutamine PA'.

Annual revisions on 01/03/2024 and 01/15/2025 noted 'No criteria changes.'

1Covered Indications

1 yrApproval Duration

>=5Min Age (yrs)

Coverage Summary

Coverage stance: covered_with_criteria. Scope: Prior authorization policy for coverage of L-glutamine oral powder (Endari and generic) for treatment of sickle cell disease in Cigna-administered benefit plans, specifying criteria, documentation and duration of approval. Approval duration: 1 year. Last review date: 01/15/2025.

Policy Summary

PayerCigna

PolicySickle Cell Disease - L-glutamine Prior Authorization Policy

Policy CodePolicy N/A

Change TypeRevisionAnnual reviews

Effective Date

Next Review Date

Key ActionPrior authorization is required for L-glutamine oral powder; approvals are provided for 1 year and documentation is required as noted in the criteria.

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.

Provider Actions

Prior Authorization

Prior authorization required

Prior authorization is recommended/required for prescription benefit coverage of L-glutamine oral powder; approvals are provided for 1 year.

Documentation Required

Documentation required

Documentation is required for use as noted in the criteria and may include chart notes, prescription claims records, prescription receipts, and/or other information.

Examples: chart notes, prescription claims records, prescription receipts, and/or other information.

Billing Rule

Prescriber specialty requirement

Medication must be prescribed by or in consultation with a physician who specializes in sickle cell disease (e.g., a hematologist).

Endari	L-glutamine oral powder (brand)
generic L-glutamine oral powder	L-glutamine oral powder (generic)

OpenPayer

Sickle Cell Disease - L-glutamine Prior Authorization Policy

Coverage Summary

Initial Therapy Criteria

Continuation Therapy Criteria

Applicable Codes

Provider Actions

Clinical Evidence & References

Background

Revision History