CurrentCignaPolicy N/A

Skyclarys (omaveloxolone) prior authorization for Friedreich's ataxia

Cigna prior authorization policy for coverage of Skyclarys (omaveloxolone capsules) primarily for treatment of Friedreich's ataxia in patients aged 16 years and older; describes medical necessity criteria, required documentation, approval durations, and non-covered indications.

Policy Summary

PayerCigna

PolicySkyclarys (omaveloxolone) prior authorization for Friedreich's ataxia

Policy CodePolicy N/A

Change TypeClarified

Effective DateN/A

Next Review DateN/A

Key ActionSubmit prior authorization with documentation including genetic testing confirming biallelic FXN pathogenic variants, recent BNP, LVEF, HbA1c, and mFARS score; ensure prescription is by or in consultation with a neurologist or ataxia specialist.

SourceLink

POLICY UPDATE CHANGES

Criteria updated to require genetic testing confirming biallelic pathogenic variants in the frataxin (FXN) gene (replaced prior language referencing trinucleotide repeat expansion assay).

≥16Minimum age for coverage

20–80mFARS score range

≤200BNP threshold

≥40LVEF threshold

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