Ophthalmic - Glaucoma - Alpha-Adrenergic Agonists Step Therapy Policy
Defines Cigna's step therapy requirements and coverage criteria for alpha-adrenergic ophthalmic agents (brimonidine and apraclonidine products) for patients with open-angle glaucoma, ocular hypertension, or peri-procedural IOP control; applies to Cigna-administered health benefit plans.
Generic brimonidine tartrate 0.1% ophthalmic solution was added to Step 1.
Coverage Criteria — Step Therapy for Alpha‑Adrenergic Ophthalmic Agents
Step therapy criteria
Ophthalmic - Glaucoma - Alpha‑Adrenergic Agonists Step Therapy Policy product(s) is(are) covered as medically necessary when the following step therapy criteria are met.
Primary coverage rules
Step 2 coverage conditions
- Condition A: Prior Step 1 trial: Patient has tried at least one Step 1 product (generic apraclonidine 0.5% ophthalmic solution OR generic brimonidine tartrate 0.1%, 0.15%, or 0.2% ophthalmic solution).
- Condition B: Peri‑procedural indication for Iopidine 1%: Patient is undergoing argon laser trabeculoplasty, argon laser iridotomy, or Nd:YAG posterior capsulotomy (approval limited to Iopidine 1%).
Ophthalmic - Glaucoma - Alpha‑Adrenergic Agonists are covered as medically necessary only when the listed step therapy conditions are met. Specifically, coverage for a Step 2 product is allowed when the patient has tried at least one Step 1 product or meets the specified peri‑procedural indication; all approvals are provided for 1 year. Any use that does not meet these step therapy criteria or the stated exceptions is considered not medically necessary.
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