DRUG QUANTITY MANAGEMENT POLICY - PER RX
Cigna Drug Quantity Management policy specifying maximum dispense quantities per prescription for imatinib tablets (Gleevec and generic) and an override for patients taking strong CYP3A4 inducers. Applies to Cigna-administered health benefit plans unless plan language or delegated vendor rules differ.
Annual review dated 12/17/2024 with no criteria changes.
Policy overview
This is the Cigna Drug Quantity Management policy for imatinib (Gleevec and generic) that defines per‑prescription maximum dispense quantities for imatinib tablet strengths and a conditional override for patients taking strong CYP3A4 inducers. It applies to Cigna‑administered health benefit plans. Key per‑Rx maximums include Gleevec 100 mg: Retail max = 180 tablets; Home Delivery max = 540 tablets, and imatinib 400 mg (generic): Retail max = 60 tablets; Home Delivery max = 180 tablets. A conditional override for patients taking strong CYP3A4 inducers permits increased limits for 400 mg tablets up to 90 tablets at retail or 270 tablets at home delivery. Prescribing information and dosing/interaction guidance are referenced in the policy.