CurrentCignaPolicy N/A

Ingrezza (valbenazine) prior authorization

Defines prior authorization requirements for Ingrezza and Ingrezza Sprinkle (valbenazine) for adults when used for FDA‑approved indications (chorea in Huntington's disease and tardive dyskinesia) for Cigna-administered benefit plans.

Policy Summary

PayerCigna

PolicyIngrezza (valbenazine) prior authorization

Policy CodePolicy N/A

Change TypeMaterial and non‑material additions

Effective Date

Next Review DateApr 10, 2024

Key ActionObtain prior authorization and document specialist involvement and genetic confirmation (when for Huntington's chorea) for approval up to 1 year.

SourceLink

POLICY UPDATE CHANGES

Chorea associated with Huntington's disease was added as an indication with specific approval criteria.

Ingrezza Sprinkle formulation was added to the policy and is subject to the same criteria as Ingrezza.

2FDA‑approved indications covered

1 yearApproval duration

≥18Minimum age

NCApplicable state

Coverage Criteria for Ingrezza (valbenazine)

Policy Summary

PayerCigna

PolicyIngrezza (valbenazine) prior authorization

Policy CodePolicy N/A

Change TypeMaterial and non‑material additions

Effective Date

Next Review DateApr 10, 2024

Key ActionObtain prior authorization and document specialist involvement and genetic confirmation (when for Huntington's chorea) for approval up to 1 year.

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.

FDA‑Approved Indications

Covered when ALL of the following are met for each indication

Chorea associated with Huntington's disease: Approve for 1 year if ALL of the following are met: (A) Patient is ≥ 18 years of age; AND (B) Diagnosis of Huntington's disease is confirmed by genetic testing (for example, an expanded HTT CAG repeat sequence of at least 36); AND (C) The medication is prescribed by or in consultation with a neurologist.1 year approval

Specialist prescriber required

Tardive dyskinesia: Approve for 1 year if BOTH of the following are met: (A) Patient is ≥ 18 years of age; AND (B) The medication is prescribed by or in consultation with a neurologist or psychiatrist.1 year approval

Specialist prescriber required

Coverage of Ingrezza (valbenazine) and Ingrezza Sprinkle is provided only for the FDA‑approved indications when all specific criteria for each indication are met. For each covered indication, the policy requires that the patient be an adult (age ≥ 18 years), that the medication be prescribed by or in consultation with the specified specialist, and that any indication‑specific diagnostic confirmation (for example, genetic confirmation for Huntington's disease) is documented. Prior authorization is required, and when criteria are met approvals are issued for 1 year.

Use of Ingrezza or Ingrezza Sprinkle for any indication other than chorea associated with Huntington's disease or tardive dyskinesia is considered experimental, investigational, or unproven and is not covered under this policy. Criteria and coverage determinations will be updated if new published data become available.

Drug Names, Age, and Coding Details

Drug names (no CPT/HCPCS specified)mixed

valbenazine

Ingrezza (valbenazine) and Ingrezza Sprinkle (valbenazine) — product names as listed; no numeric codes provided in document

Age — minimum patient age for covered indications

Minimum age>= 18 years

Applies to indicationsChorea associated with Huntington's disease; Tardive dyskinesia

Approval duration when criteria met1 year

Genetic test threshold for Huntington's disease

Genetic test thresholdHTT CAG repeat >= 36 (example)

Use required forConfirmation of Huntington's disease diagnosis for chorea indication

DocumentationGenetic testing result must be provided as part of prior authorization

Provider Actions, Authorization, and Documentation Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for Ingrezza and Ingrezza Sprinkle. Approvals are provided for 1 year when specified criteria are met.

Affected products: Ingrezza (valbenazine capsules) and Ingrezza Sprinkle (valbenazine capsules)

Step Therapy

No step therapy requirements are specified in this policy.

Documentation Required

Required Clinical Documentation

Prescriber specialty documentation is required. The prescription must be written by or in consultation with an appropriate specialist: neurologist for chorea associated with Huntington's disease; neurologist or psychiatrist for tardive dyskinesia. Documentation should confirm age and diagnosis criteria as applicable (e.g., patient ≥ 18 years; for Huntington’s disease, genetic confirmation such as expanded HTT CAG repeat ≥ 36).

Chorea associated with Huntington's disease: prescribed by or in consultation with a neurologist; documentation of genetic testing confirming Huntington's disease (e.g., HTT CAG repeat ≥ 36); patient ≥ 18 years.
Tardive dyskinesia: prescribed by or in consultation with a neurologist or psychiatrist; patient ≥ 18 years.

Denial Risk

Non‑covered Indications

Use of Ingrezza or Ingrezza Sprinkle for any indication other than the listed FDA‑approved indications is considered not medically necessary.

Background

Valbenazine (marketed as Ingrezza and Ingrezza Sprinkle) is a vesicular monoamine transporter type 2 (VMAT2) inhibitor approved in adults for treatment of hyperkinetic movement disorders included in this policy: chorea associated with Huntington's disease and tardive dyskinesia. The policy requires specialist involvement (neurologist for chorea; neurologist or psychiatrist for tardive dyskinesia) and, for the chorea indication, documented genetic confirmation (example threshold: HTT CAG repeat ≥ 36) when applicable.

Definitions and Key Terms

Vesicular monoamine transporter type 2 inhibitor (VMAT2 inhibitor) — drug class

Drug classVesicular monoamine transporter type 2 (VMAT2) inhibitor

Example agents in policyIngrezza and Ingrezza Sprinkle (valbenazine)

Indications related to classUsed to treat hyperkinetic movement disorders such as chorea and tardive dyskinesia

Genetic confirmation of Huntington's disease — confirmation via genetic testing showing expanded HTT CAG repeat

Definition for coverageDiagnosis of Huntington's disease confirmed by genetic testing showing expanded HTT CAG repeat (for example, >= 36 repeats)

PurposeRequired to meet coverage criteria for chorea associated with Huntington's disease

Related requirementGenetic confirmation must be accompanied by neurologist involvement for approval