CurrentCignaPolicy PSM009

Inflammatory Conditions - Cosentyx (secukinumab) Intravenous non-preferred product exception criteria

Defines prior-authorization and non-preferred product exception criteria for Cosentyx intravenous when requested under Cigna-administered prescription drug benefits for certain employer plans (Standard/Performance, Value/Advantage, Total Savings). Applies to coverage decisions for ankylosing spondylitis, non-radiographic axial spondyloarthritis, and psoriatic arthritis.

Policy Summary

PayerCigna

PolicyInflammatory Conditions - Cosentyx (secukinumab) Intravenous non-preferred product exception criteria

Policy CodePolicy PSM009

Change TypeNew policy with subsequent selected and annual revisions

Effective DateApr 15, 2026

Next Review Date

Key ActionSubmit prior authorization requests that meet the standard Cosentyx Intravenous prior authorization criteria and provide documented trials of required Step 1/Step 2 preferred agents when seeking a non-preferred product exception.

SourceLink

POLICY UPDATE CHANGES

New policy created (PSM009) with initial effective/new date 11/01/2024 and multiple subsequent selected and annual revisions through 04/15/2026.

3Indications listed for Cosentyx IV (AS, nr-axSpA, PsA)

6 monthsInitial approval duration for non-preferred exception when criteria met

1 yearApproval duration for continuation therapy when currently receiving Cosentyx

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Cosentyx (secukinumab) IV — Coverage Criteria

General program and documentation requirements

Cosentyx intravenous is considered medically necessary only when non-preferred product exception criteria are met in addition to standard prior authorization criteria. Documentation of prior trials is required when noted.

ALL of the following

Patient meets the standard Inflammatory Conditions - Cosentyx Intravenous Prior Authorization Policy criteria
Refer to the standard prior authorization policy for baseline clinical requirements
When documentation is required, prescriber must provide written documentation of trials (e.g., chart notes, prescription claims, receipts) including patient-specific identifying information
Documentation required where indicated in specific condition criteria

Ankylosing Spondylitis — Initial Therapy

Approve for 6 months if ALL of the following are met:

ALL of the following

Patient meets the standard Inflammatory Conditions - Cosentyx Intravenous Prior Authorization Policy criteria
Patient has tried TWO of the following: Enbrel, an adalimumab product, Rinvoq, Taltz, and Xeljanz/XR
A trial of multiple adalimumab products counts as ONE product; trials must be documented

Non-Radiographic Axial Spondyloarthritis (nr-axSpA) — Initial Therapy

Approve for 6 months if ALL of the following are met:

ALL of the following

Patient meets the standard Inflammatory Conditions - Cosentyx Intravenous Prior Authorization Policy criteria
Patient has tried TWO of the following: Cimzia, Taltz, and Rinvoq
Other agents (e.g., Enbrel, adalimumab products, infliximab products, Simponi, Bimzelx) may also count; trials must be documented; multiple adalimumab products count as ONE product

Psoriatic Arthritis — Initial Therapy

Approve for 6 months if ALL of the following are met:

ALL of the following

Patient meets the standard Inflammatory Conditions - Cosentyx Intravenous Prior Authorization Policy criteria
Patient has tried TWO of the following: Enbrel, an adalimumab product, Otezla/Otezla XR, Rinvoq/Rinvoq LQ, Skyrizi SC, an ustekinumab SC product, Taltz, Tremfya, and Xeljanz/XR
A trial of multiple adalimumab products counts as ONE product; multiple ustekinumab products count as ONE product; trials must be documented

Patients Currently Receiving Cosentyx (SC or IV) — Continuation Therapy

Approve for 1 year if ALL of the following are met:

ALL of the following

Patient meets the standard Inflammatory Conditions - Cosentyx Intravenous Prior Authorization Policy criteria
AND one of the following (a–d):
- Patient has Ankylosing Spondylitis and has tried TWO of Enbrel, an adalimumab product, Rinvoq, Taltz, and Xeljanz/XR
  Trials documented; adalimumab product grouping rules apply
- Patient has nr-axSpA and has tried TWO of Cimzia, Taltz, and Rinvoq
  Other agents (Enbrel, adalimumab products, infliximab products, Simponi, Bimzelx) may also count; trials documented
- Patient has Psoriatic Arthritis and has tried TWO of Enbrel, an adalimumab product, Otezla/Otezla XR, Rinvoq/Rinvoq LQ, Skyrizi subcutaneous, an ustekinumab subcutaneous product, Taltz, Tremfya, or Xeljanz/XR

If step requirements not met

When standard prior authorization criteria are met but required Step 1 product trial(s) are not met:

ANY of the following

A request for a Step 1 Product may be reviewed using the respective standard Inflammatory Conditions - Prior Authorization Policy criteria (lists of Step 1 agents provided per indication)

Codes, NDCs and Named Products Referenced

NDC-noted Preferred products or exceptions called outmixed

adalimumab-ryvk NDCs starting with 82009	Specified as Preferred adalimumab product when NDC matches
Imuldosa NDCs starting with 69448	Specified as Preferred ustekinumab subcutaneous product (added 01/01/2026)

Named products referenced in criteria (examples)mixed

Cosentyx IV	secukinumab intravenous (non-preferred product exception target)
Enbrel	etanercept (preferred agent in many Step 1 lists)
Adalimumab products	Humira and multiple biosimilars/alternatives (grouped as one trial when multiple tried)
Rinvoq	upadacitinib (including Rinvoq LQ grouping rule)
Taltz	ixekizumab
Xeljanz/XR	tofacitinib immediate and extended release (count collectively as one trial)
Cimzia	certolizumab pegol
Otezla/Otezla XR	apremilast (counts collectively as one trial)
Skyrizi SC	risankizumab subcutaneous
Ustekinumab SC products	Stelara and multiple listed biosimilars/alternatives; multiple ustekinumab products count as one trial

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What Providers Must Do

Prior Authorization

Prior authorization required

Cosentyx intravenous (Cosentyx IV) requests must meet the standard Inflammatory Conditions - Cosentyx Intravenous Prior Authorization Policy criteria and, for non-preferred product exception approval, must also meet the indication-specific Step 1/Step 2 trial criteria (e.g., required trials of two Step 1 preferred agents for initial exception approval).

Codes: Cosentyx IV; See standard Inflammatory Conditions - Cosentyx Intravenous Prior Authorization Policy

Documentation Required

Document trials of preferred agents

Prescribers must submit written documentation to support prior trials of Step 1/Step 2 agents where noted; acceptable documentation includes chart notes, prescription claims records, and/or prescription receipts and must include patient-specific identifying information.

Documentation must include patient-identifying information (e.g., name, DOB, member ID)

Approval Durations and Trial Thresholds

Approval and trial thresholds

Initial approval duration (non-preferred exception)6 months

Continuation approval duration (currently receiving Cosentyx)1 year

Established on Cosentyx for continuation without step trials>= 90 days

Step trial count required for initial exception2 preferred products (per indication)

3Indications listed for Cosentyx IV (AS, nr-axSpA, PsA)

6Initial approval duration (months) for non-preferred exception

Clinical and Program Background

Cosentyx intravenous (secukinumab) is an interleukin‑17A (IL‑17A) antagonist approved for adults with active psoriatic arthritis, ankylosing spondylitis, and non‑radiographic axial spondyloarthritis with objective signs of inflammation. The indications and mechanism are described in the product prescribing information and summarized in this Coverage Policy.

This document defines the Preferred Specialty Management requirements when Cosentyx IV is requested under Cigna‑administered prescription drug benefits for the listed employer plan types. In addition to meeting the standard Inflammatory Conditions prior authorization criteria for Cosentyx IV, requests for Cosentyx IV that are considered Non‑Preferred Product Exception approvals must meet indication‑specific Step trial requirements before approval.

As part of the Preferred Specialty Management program, the policy requires trials of Step 1 Preferred Products (indication‑specific biologic and oral options such as Enbrel, adalimumab products, Rinvoq, Taltz, Cimzia, Otezla/Otezla XR, Skyrizi SC, ustekinumab SC products, etc.) prior to approval of the non‑preferred Cosentyx IV, unless other exception criteria apply. When documentation of prior trials is required, the prescriber must submit written documentation (for example, chart notes, prescription claims, or receipts) that includes patient‑identifying information.

The program also specifies grouping rules for trial counts: a trial of multiple products from the same molecule (for example, multiple adalimumab products or multiple ustekinumab products) counts as ONE product trial, and certain product pairs (for example, Xeljanz/XR, Rinvoq/Rinvoq LQ, Otezla/Otezla XR) collectively count as ONE trial. See the indication‑specific sections for the exact Step product lists and required trial counts.

Defined Terms

Definitions

Step 1 Preferred ProductPreferred agents listed per indication (examples include Enbrel, adalimumab products, Rinvoq, Taltz, Cimzia, Otezla/Otezla XR, Skyrizi SC, ustekinumab SC products, Tremfya, Xeljanz/XR). These lists are indication-specific.

Trial countsA trial of multiple products from the same molecule (e.g., multiple adalimumab products or multiple ustekinumab products) counts as ONE product trial. Certain product pairs (Xeljanz/XR, Rinvoq/Rinvoq LQ, Otezla/Otezla XR) collectively count as one trial.

Policy Update Changes

11/01/2024New policy created

New policy PSM009 created with initial effective date 11/01/2024.

01/01/2025Selected revision

Policy name changed; Humira (NDCs starting with 00074) and Hyrimoz (NDCs starting with 61314) were removed from the Preferred Products for Ankylosing Spondylitis and Psoriatic Arthritis.

04/15/2025Annual revision

Adalimumab-adaz removed as a Preferred Product and examples of ustekinumab products updated throughout the policy.

Inflammatory Conditions - Cosentyx (secukinumab) Intravenous non-preferred product exception criteria

Cosentyx (secukinumab) IV — Coverage Criteria

Codes, NDCs and Named Products Referenced

What Providers Must Do

Approval Durations and Trial Thresholds

Clinical and Program Background

Defined Terms

Policies to Read With This Policy

Policy Update Changes