CurrentCignaPolicy IP0560
Teriflunomide for Individual and Family Plans
Cigna coverage policy for teriflunomide (Aubagio and generic teriflunomide tablets) for Individual and Family Plans, defining medical necessity criteria for initiation and continuation in adults with relapsing forms of multiple sclerosis, exclusions, prescribing requirements, and documentation expectations.
Policy Summary
PayerCigna
PolicyTeriflunomide for Individual and Family Plans
Policy CodePolicy IP0560
Change TypeCriteria updates; specialist requirement; generic-first language
Effective DateDec 1, 2024
Next Review Date
Key ActionProvide documentation evidencing relapsing form of MS, specialist prescribing or consultation, and for continuation, objective measures or symptom stabilization/improvement; prior authorization may be required.
POLICY UPDATE CHANGES
Added a definition for documentation.
Added a specialist prescribing requirement.
Added criteria for patient Currently Receiving Teriflunomide for ≥ 1 Year.
Updated the preferred product multi-source brand language to current standards.
Ocrevus Zunovo was added to the Appendix.
1FDA-Approved Indication Covered
≥1 yearContinuation therapy minimum duration
Non-relapsing forms