CurrentCignaPolicy IP0258

Riluzole Products

This Cigna drug coverage policy governs prior authorization and coverage criteria for riluzole formulations (oral tablets, oral film, oral suspensions) for patients with amyotrophic lateral sclerosis (ALS) under Cigna-administered plans.

Policy Summary

PayerCigna

PolicyRiluzole Products

Policy CodePolicy IP0258

Change TypeAdded preferred productsrevised step requirements

Effective DateMay 15, 2025

Next Review DateJul 1, 2025

Key ActionObtain prior authorization; approvals provided for 1 year when ALS criteria are met.

SourceLink

POLICY UPDATE CHANGES

Teglutik (riluzole oral suspension) was added to the preferred product table for Individual and Family Plans (IFP) and Employer Plans (Emp).

Criteria for Exservan and Tiglutik were updated to add additional 'tried' criteria requiring trial of alternatives before coverage.

Exservan and Tiglutik products were added for Individual and Family Plans.

Documented diagnosis requirement language was removed from the ALS criteria.

3formulations listed

1 yearapproval duration (ALS)

50 mg twice dailyrecommended dosage

Level AAAN recommendation

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.

Coverage Criteria for Riluzole Products

inv-01: Initial coverage for ALS

Riluzole products are considered medically necessary when ALL of the following are met for ALS:

ALS diagnosis and prescriber: Patient has amyotrophic lateral sclerosis (ALS) and the agent is prescribed by or in consultation with a neurologist, a neuromuscular disease specialist, or a physician specializing in the treatment of ALS.Approve for 1 year if met

Product-specific preferred product criteria: Preferred product criteria for the requested riluzole formulation are met as described in the Employer Plans or Individual and Family Plans tables (trial of generic riluzole tablets and/or oral suspension, or inability to swallow tablets).

See product-specific branches below

inv-02: Preferred product and step requirements

For each plan type, coverage of specific formulations requires ONE of the listed conditions:

Exservan (riluzole oral film) - Employer Plans: Either (a) patient has tried BOTH of the following: (i) generic riluzole tablets AND (ii) Teglutik/Tiglutik oral suspension (prior authorization required for suspension), OR (b) patient cannot swallow or has difficulty swallowing tablets and has tried Teglutik/Tiglutik oral suspension (prior authorization required).

Employer plan specific

Teglutik/Tiglutik (riluzole oral suspension) - Employer Plans: Either (a) patient has tried generic riluzole tablets, OR (b) patient cannot swallow or has difficulty swallowing tablets.

Employer plan specific

Exservan (riluzole oral film) - Individual and Family Plans: Either (a) patient has tried generic riluzole tablets, OR (b) patient cannot swallow or has difficulty swallowing tablets.

IFP specific

Teglutik/Tiglutik (riluzole oral suspension) - Individual and Family Plans: Either (a) patient has tried generic riluzole tablets, OR (b) patient cannot swallow or has difficulty swallowing tablets.

Riluzole products used for any indication other than amyotrophic lateral sclerosis (ALS) are considered not medically necessary and are not covered under this policy. This exclusion reflects the absence of approved or supported indications for non‑ALS uses in the evidence reviewed and will be revisited if new published data become available.

Use of riluzole products for indications other than amyotrophic lateral sclerosis (ALS) is considered not medically necessary. Requests for riluzole for non‑ALS diagnoses should be denied as not covered per this policy.

Coding and Approval Duration

Coding notesmixed

Policy states claims not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered. Coverage Policies relate to administration of health benefit plans and reimbursement is not allowed for services billed for conditions or diagnoses that are not covered under this Coverage Policy. When billing, providers must use the most appropriate codes as of the effective date of the submission.

Approval duration for ALS

Approval duration when ALS criteria metApprove for 1 year when both ALS diagnosis and prescriber criteria and preferred product criteria are met.

Prior authorization requirementPrior Authorization is recommended for Riluzole; approvals are provided for the duration noted (see approval duration).

Prescriber requirement tied to approvalApproval requires Riluzole to be prescribed by or in consultation with a neurologist, neuromuscular disease specialist, or physician specializing in ALS.

Provider Requirements and Prior Authorization

Prior Authorization

Prior Authorization Required

Prior authorization is recommended for Riluzole products. Approvals are provided for the durations specified in the policy (for ALS, approve for 1 year when criteria are met). Because of the specialized skills required for evaluation, diagnosis, and monitoring, Riluzole must be prescribed by or in consultation with an appropriate specialist (e.g., neurologist, neuromuscular disease specialist, or a physician specializing in ALS).

Approval duration: 1 year for ALS when criteria met (1 month = 30 days).
Prescriber requirement: prescribed by or in consultation with a neurologist, neuromuscular disease specialist, or physician specializing in ALS.

Step Therapy

Step Therapy / Trial Requirements

For preferred branded products (Exservan, Teglutik, Tiglutik), the policy requires trials of alternative formulations before coverage of the brand is authorized. Step therapy requirements differ by market (Employer vs Individual/Family) as detailed below.

Employer Plans — Exservan: Trial of BOTH generic riluzole tablets AND Teglutik/Tiglutik oral suspension, OR if patient cannot swallow tablets, trial of Teglutik/Tiglutik suspension. Employer Plans — Teglutik: Trial of generic riluzole tablets OR inability to swallow tablets. Employer Plans — Tiglutik: Trial of generic riluzole tablets OR inability to swallow tablets.
Individual & Family Plans — Exservan: Trial of generic riluzole tablets OR inability to swallow tablets. Individual & Family Plans — Teglutik: Trial of generic riluzole tablets OR inability to swallow tablets. Individual & Family Plans — Tiglutik: Trial of generic riluzole tablets OR inability to swallow tablets.

Billing Rule

Coding and Claim Submission

Claims submitted without covered diagnosis or procedure codes under the applicable Coverage Policy will be denied as not covered. When billing, providers must use the most appropriate codes as of the effective date of submission.

Claims lacking covered codes per the Coverage Policy will be denied as not covered.

OpenPayer

Riluzole Products

Coverage Criteria for Riluzole Products

Coding and Approval Duration

Provider Requirements and Prior Authorization

Background

Definitions