Oncology (Oral - Fibroblast Growth Factor Receptor Agent) - Pemazyre PA Policy
Cigna prior authorization policy for outpatient prescription coverage of Pemazyre (pemigatinib) for adults with specified FGFR-driven malignancies; applies to Cigna-administered benefit plans unless a customer's plan document or delegated vendor rules override.
Policy name was changed to 'Oncology (Oral - Fibroblast Growth Factor Receptor Agent) - Pemazyre PA Policy'.
Added 'gross residual disease' as an option for approval in cholangiocarcinoma eligibility.
Clarified FGFR2 criterion wording by adding the word 'gene' to describe FGFR2 fusion/rearrangement.
Removed examples of certain systemic regimens (FOLFOX, FOLFIRI, Stivarga) from the policy notes.
Removed requirement that myeloid/lymphoid neoplasms be in chronic or blast phase for approval.
Medical Necessity Criteria
FDA-Approved Indication: Cholangiocarcinoma (pemigatinib)
Approve for 1 year if the patient meets ALL of the following (A, B, C, and D):
ALL of the following
- Patient is ≥ 18 years of age
- Patient has unresectable locally advanced, gross residual, or metastatic disease
- Tumor has fibroblast growth factor receptor 2 (FGFR2) gene fusion or other rearrangement, as detected by an approved test
Detection must be by an approved test (per policy)
- Patient has been previously treated with at least one systemic regimen
Examples of systemic regimens provided (non-exhaustive): gemcitabine + cisplatin; 5-fluorouracil + oxaliplatin or cisplatin; capecitabine + cisplatin or oxaliplatin; gemcitabine + nab-paclitaxel (Abraxane) +/- other agents
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.