Inflammatory Conditions - Adalimumab Products Drug Quantity Management Policy - Per Days
Cigna coverage policy governing drug quantity management (per days) for adalimumab and its biosimilars for inflammatory conditions; applies to health benefit plans administered by Cigna companies. Affects providers seeking coverage/authorization for listed adalimumab products.
New override criteria were added to approve a one-time override for 3 additional 80 mg pens at retail or home delivery for initiation or additional induction dosing for Crohn's disease in patients ≥18 years or 6–17.
Policy statement clarified that 'one-time' approvals are provided for 30 days unless otherwise noted, and that all adalimumab products of the same strength accumulate toward the total quantity limit.
Override amounts for hidradenitis suppurativa were revised: one-time override changed to 3 additional 80 mg pens at retail (previously 4) and 7 at home delivery (previously 8).
Specific starter pack override rules defined for multiple starter pack compositions (various combinations of 40 mg and 80 mg pens or syringes) authorizing one-time overrides when no adalimumab claims in past 130 days.
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