CurrentCignaPolicy N/A

Parkinson's Disease - Monoamine Oxidase Type B Inhibitors Step Therapy Policy

Defines Cigna's step therapy requirement that patients try generic selegiline or generic rasagiline (Step 1) before coverage of branded Step 2 MAO-B inhibitors (Azilect, Xadago); applies to Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyParkinson's Disease - Monoamine Oxidase Type B Inhibitors Step Therapy Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateJan 15, 2025

Key ActionRequire trial of one Step 1 product (generic selegiline or generic rasagiline) before approving a Step 2 product; approvals are granted for 1 year.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2-steptherapy steps (Step 1 → Step 2)

3 productsMAO-B inhibitors named in policy

1 yearapproval duration for exceptions

No criteria changesmost recent annual revision note

Coverage Criteria for MAO-B Inhibitors

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Step 2 coverage criteria

Covered when ALL of the following are met:

Step therapy sequence: Patient has trialed one Step 1 product (generic selegiline tablets or capsules OR generic rasagiline tablets).trial of one Step 1 product

If met, a Step 2 product (Azilect or Xadago) is approved for 1 year.

Provider Requirements and Prior Authorization

Prior Authorization

Approval duration & exception

All approvals are provided for 1 year in duration. Zelapar (selegiline orally disintegrating tablets) is exempt from the Step Therapy requirement and does not require prior step completion for coverage.

Step Therapy

Step therapy requirement

A Step 1 Product must be tried and documented before coverage of a Step 2 Product is approved. Step 1 = generic selegiline (tablets or capsules) or generic rasagiline (tablets). Step 2 = Azilect or Xadago. If the Step Therapy rule is not met at point of service, coverage will be determined by the Step Therapy criteria and a denial may occur.

Step 1: generic selegiline tablets and capsules, generic rasagiline tablets
Step 2: Azilect, Xadago
If patient has tried one Step 1 Product, approve a Step 2 Product

Denial Risk

Denial risk for failing step requirement

If the Step Therapy requirement for a Step 2 Product is not met at the point of service, the claim may be denied; coverage will be determined based on the Step Therapy criteria. Providers should document prior use of an approved Step 1 Product to avoid denial at point of service.

Definitions

MAO-B inhibitors — definition and examples

Examples (named in policy)Rasagiline (Azilect), Selegiline (oral tablets and capsules; Zelapar oral disintegrating tablet noted separately), Safinamide (Xadago).

Typical indicationsRasagiline and selegiline: efficacious and clinically useful for symptomatic monotherapy; safinamide (Xadago) and rasagiline: efficacious for treatment of motor fluctuations/"off" episodes when used adjunctively with levodopa/carbidopa.

Formulations referencedSelegiline tablets and capsules (adjunct to levodopa/carbidopa); Zelapar (selegiline ODT) noted in policy exclusions; Azilect (rasagiline) and Xadago (safinamide) branded products referenced.

Clinical evidence notedInternational Parkinson and Movement Disorder Society (2018) evidence review cited for efficacy distinctions among agents.

Background

Monoamine oxidase B (MAO-B) inhibitors — including selegiline, rasagiline, and safinamide — are used in the management of Parkinson’s disease. This policy implements a Step Therapy approach that requires trial of a Step 1 product (generic selegiline tablets or capsules or generic rasagiline tablets) before approval of a Step 2 product (Azilect or Xadago). All Step Therapy approvals are provided for 1 year. Note that Zelapar (selegiline ODT) is an exception and does not require Step Therapy.