CurrentCignaPolicy N/A

Parkinson's Disease Apomorphine Subcutaneous Prior Authorization Policy

Prior authorization policy governing coverage of apomorphine subcutaneous (Apokyn® and generic) for treatment of OFF episodes in patients with Parkinson's disease for Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyParkinson's Disease Apomorphine Subcutaneous Prior Authorization Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateMar 12, 2025

Key ActionObtain prior authorization and approve for 1 year if the patient meets all listed criteria.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

FDA-approved indicationcovered for

1 yearinitial approval duration

contraindicatedconcurrent use with 5-HT3 antagonists

neurologistprescriber requirement

last reviewreview date

Coverage Criteria for Apomorphine Subcutaneous

FDA-Approved Indication

Covered when ALL of the following are met

FDA-Approved Indication criteria: A) Patient is experiencing 'off' episodes.

Examples of 'off' episodes include muscle stiffness, slow movements, or difficulty starting movements.

B) Patient is currently receiving carbidopa/levodopa therapy.

ALL of the following

ONE of: i) Patient had significant intolerance to that treatment, according to the prescriber.
ii) Patient had inadequate efficacy of that treatment, according to the prescriber.

Policy Summary

PayerCigna

PolicyParkinson's Disease Apomorphine Subcutaneous Prior Authorization Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateMar 12, 2025

Key ActionObtain prior authorization and approve for 1 year if the patient meets all listed criteria.

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.

Provider Requirements and Authorization

Prior Authorization

Prior Authorization Required

Prior authorization is required. Approvals are for 1 year when criteria are met.

Prior authorization required
Approval duration: 1 year if criteria met

Step Therapy

Step Therapy Requirement

Patient must have tried one other therapy for 'off' episodes with documented intolerance or inadequate efficacy (per prescriber).

Step requirement: trial of one other treatment for 'off' episodes (e.g., entacapone, rasagiline, pramipexole, ropinirole, tolcapone, cabergoline, selegiline, opicapone, safinamide)
Documentation of intolerance or inadequate efficacy required

Documentation Required

Documentation Requirements

Required clinical documentation includes evidence of 'off' episodes, current carbidopa/levodopa use, documentation of prior trial of another treatment with intolerance or inadequate efficacy, and that the medication is prescribed by or in consultation with a neurologist.

Evidence of 'off' episodes (e.g., muscle stiffness, slow movements, difficulty initiating movement)
Current carbidopa/levodopa therapy
Documentation of prior trial and reason for failure (intolerance or inadequate efficacy)
Prescriber is a neurologist or consult with a neurologist

Denial Risk

5-HT3 Antagonist Contraindication

Concurrent use of apomorphine subcutaneous with a serotonin 5-HT3 antagonist (e.g., ondansetron, granisetron, dolasetron, palonosetron, alosetron) is an absolute contraindication due to risk of severe hypotension and loss of consciousness. Do not approve when 5-HT3 antagonists are being used concurrently.

Absolute contraindication: concurrent use with serotonin 5-HT3 antagonists (ondansetron, granisetron, dolasetron, palonosetron, alosetron)
If patient is taking a 5-HT3 antagonist, obtain confirmation of discontinuation prior to approval

OpenPayer

Parkinson's Disease Apomorphine Subcutaneous Prior Authorization Policy

Coverage Criteria for Apomorphine Subcutaneous

Provider Requirements and Authorization

Background

Definitions