CurrentCignaPolicy IP0462

Albendazole (tablet) — Coverage Criteria

Defines medical necessity criteria, authorization durations, and conditions covered for albendazole tablets for Cigna-administered health benefit plans (Individual and Family Plans). Applies to providers requesting coverage for listed parasitic infections.

Policy Summary

PayerCigna

PolicyAlbendazole (tablet) — Coverage Criteria

Policy CodePolicy IP0462

Change TypeNo material changes

Effective DateJan 1, 2023

Next Review DateJan 1, 2024

Key ActionObtain prior authorization with documentation of the infection and involvement of an infectious disease or tropical disease specialist.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

15+indications listed

Up to 6 mohydatid authorization

Up to 1 moother indications auth

Requiredspecialist requirement

Coverage Criteria

Covered when BOTH of the following are met:

ALL of the following

- Ascariasis.
- Clonorchis sinensis or Opisthorchis viverrini infection.
- Cutaneous larva migrans.
- Cystic hydatid disease due to Echinococcus granulosus.
- Enterobiasis.

Policy Summary

PayerCigna

PolicyAlbendazole (tablet) — Coverage Criteria

Policy CodePolicy IP0462

Change TypeNo material changes

Effective DateJan 1, 2023

Next Review DateJan 1, 2024

Key ActionObtain prior authorization with documentation of the infection and involvement of an infectious disease or tropical disease specialist.

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.

Eosinophilic enterocolitis caused by Ancylostoma caninum.

Giardiasis caused by Giardia duodenalis.

Gnathostomiasis caused by Gnathostoma spinigerum.

Gongylonemiasis caused by Gongylonema spp.

Oesophagostomum bifurcum infection.

Trichinellosis caused by Trichinella spiralis or other Trichinella spp.

Prescribed by or in consultation with an infectious disease or tropical disease specialist.

Any other use is considered experimental, investigational or unproven.

Provider Actions & Authorization

Prior Authorization

Prior Authorization Required

Prior authorization is required. Requests must document the specific infection being treated and confirmation that the prescriber is an infectious disease or tropical disease specialist or that treatment was provided in consultation with such a specialist. Initial approval durations: Hydatid disease — up to 6 months; all other listed indications — up to 1 month. Reauthorization: not applicable.

Required documentation: clinical findings and appropriate laboratory confirmation of the diagnosed infection.
Include specialist involvement: prescribing clinician is an infectious disease or tropical disease specialist, or documentation of consultation.
Initial approval durations: Hydatid disease — up to 6 months; other approved indications — up to 1 month.
Reauthorization: Not applicable.

Denial Risk

Unlisted Indications

Use of albendazole for any condition other than the infections listed in the medical necessity criteria is considered experimental, investigational, or unproven and may be denied.

Unlisted indications are not covered and may be denied.

Denial Risk

Specialist Prescriber Requirement

If albendazole is not prescribed by or in consultation with an infectious disease or tropical disease specialist, coverage may be denied. Ensure the specialty of the prescriber is documented or include records of consultation with the appropriate specialist.

Prescriber requirement: infectious disease or tropical disease specialist OR documented consultation.
Absence of specialist involvement may result in denial.

Dosing & Patient Thresholds

Patient weight threshold

Weight categoriesTwo dosing categories defined: ≥ 60 kg and < 60 kg (guides albendazole dosing).

Dosing for ≥ 60 kgHydatid disease and neurocysticercosis: 400 mg twice daily with meals.

Dosing for < 60 kgHydatid disease and neurocysticercosis: 15 mg/kg/day divided twice daily with meals (maximum total daily dose 800 mg).

Maximum daily doseFor patients < 60 kg the maximum total daily dose is 800 mg.

Definitions

Hydatid Disease

DefinitionCystic hydatid disease of the liver, lung, and peritoneum caused by the larval form of Echinococcus granulosus.

Typical sitesLiver, lung, and peritoneum.

Causative organismLarval form of the dog tapeworm, Echinococcus granulosus.

Neurocysticercosis

DefinitionParenchymal neurocysticercosis due to active lesions caused by larval forms of Taenia solium.

Causative organismLarval forms of the pork tapeworm, Taenia solium.

Affected tissueParenchymal brain tissue (active lesions).

Background

Albendazole is an anthelmintic agent used to treat a range of parasitic infections. Selection of albendazole, including the prescribed dose and duration, depends on the specific parasite, the clinical severity of infection, and patient factors such as weight; dosing guidance in this policy distinguishes patients < 60 kg versus those ≥ 60 kg for certain indications.

Clinical context matters: albendazole is commonly used for conditions referenced in this policy such as cystic hydatid disease and neurocysticercosis, and treatment decisions should be based on diagnosed infection, appropriate laboratory or imaging confirmation, and evidence-based dosing and duration recommendations.