CurrentCignaPolicy N/A

Infectious Disease - Ivermectin Tablets Prior Authorization Policy

Defines prior authorization recommendation, medical necessity coverage, and non-covered uses for ivermectin tablets (Stromectol/generic) for Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyInfectious Disease - Ivermectin Tablets Prior Authorization Policy

Policy CodePolicy N/A

Change TypeClarified (annual revisionno criteria changes)

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and document a diagnosis that matches an FDA-approved or supportive-evidence indication to receive a one-month approval for ivermectin tablets.

SourceLink

POLICY UPDATE CHANGES

Annual revision performed with no criteria changes (review date 02/26/2025).

13Specific FDA-approved or supported indications listed for approval

1 monthStandard approval duration for covered indications

1Indication explicitly listed as not covered (COVID-19)

Ivermectin (Stromectol) — Coverage and Prior Authorization Rules

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FDA-Approved Indications (Covered)

Approve for one month when the diagnosis matches either FDA-approved indication:

One of the following FDA-approved indications

Onchocerciasis infection (Onchocerca volvulus).
Ivermectin has no activity against adult O. volvulus nodules; surgical excision is recommended for nodules.
Strongyloidiasis (intestinal, non-disseminated) due to Strongyloides stercoralis.

Other Uses with Supportive Evidence (Covered)

Approve for one month when the diagnosis matches one of the following parasitic infections with supportive evidence:

ANY of the following

Ascariasis.
Demodex folliculorum infection.
Enterobiasis (pinworm infection).
Gnathostomiasis.
Hookworm-related cutaneous larva migrans.
Mansonella ozzardi infection.
Mansonella streptocerca infection.
Pediculosis - approve if ONE of the following holds
- Infection caused by Pediculus humanus capitis (head lice).
- Infection caused by Pediculus humanus corporis (body lice).
- Pediculosis pubis caused by Phthirus pubis (pubic lice).
Scabies - approve if ONE of the following holds
- Classic scabies.
- Treatment-resistant scabies.
- Unable to tolerate topical treatment for scabies.
- Crusted scabies (Norwegian scabies).
- Using ivermectin tablets for prevention and/or control of scabies.
Trichuriasis.
Wuchereria bancrofti infection (lymphatic filariasis).

What Providers Must Do

Prior Authorization

Prior authorization required

Prior authorization is recommended for prescription benefit coverage of ivermectin tablets; approvals are provided for one month (30 days).

Documentation Required

Indication documentation

Provider must document the diagnosis/indication that matches one of the approved FDA or supportive-evidence uses to justify approval.

Denial Risk

Potential denial for COVID-19 use

Requests for ivermectin tablets for treatment of COVID-19 are considered experimental/unproven and are not covered; expect denial except in the context of a clinical trial per IDSA guidance.

Clinical and Administrative Background

Ivermectin tablets (Stromectol and generics) are an anthelmintic with FDA-approved indications for onchocerciasis (Onchocerca volvulus) and intestinal (non-disseminated) strongyloidiasis (Strongyloides stercoralis). The prescribing information states ivermectin is given as a single oral dose for these indications, and the policy requires documentation of an FDA-approved diagnosis for coverage consideration. [[4],[6],[7],[12]]

Although the FDA labeling specifies a single-dose regimen for onchocerciasis and strongyloidiasis, some clinical references note a 2-day regimen may be used for treatment of strongyloidiasis; the policy acknowledges this variation in source guidance. All approvals authorized under this policy are provided for one month (30 days) to allow the patient time to receive the required number of doses. [[4],[6]]

Ivermectin has multiple off‑label uses with supportive evidence and is identified by the CDC and other references as a treatment option for a range of parasitic infections. Covered non‑FDA but supported indications in this policy include ascariasis, enterobiasis (pinworm), gnathostomiasis, hookworm‑related cutaneous larva migrans, Demodex folliculorum infection, Mansonella ozzardi and M. streptocerca infections, pediculosis (head, body, and pubic lice), scabies (including treatment‑resistant and crusted scabies or when topical therapy cannot be tolerated), trichuriasis, and Wuchereria bancrofti infection. CDC guidance and referenced literature are cited for these supportive uses. [[5],[7]]

Use of ivermectin tablets for COVID‑19 is considered experimental, investigational, or unproven and is not covered; the IDSA reviewed clinical trial data and recommends against routine use of ivermectin for COVID‑19 except in clinical trials. Providers requesting ivermectin for treatment of COVID‑19 should expect denial absent enrollment in an appropriate clinical trial. [[9]]

Policy Updates

2025-02-26Annual revisionLatest

Annual revision performed with no criteria changes; document review date 02/26/2025.

2024-02-28Early annual revision

Early annual edits removed the approvable dose counts for all indications; approval durations remained one month.

2023-09-13Annual revision

Annual revision performed with no criteria changes (review date 09/13/2023).