CurrentCignaPolicy 989959 HCP 2026 Pathwell Specialty

Cigna Pathwell Specialty Drug List (non-covered medications and recent FDA approvals)

Lists specialty medications that are not covered on the Cigna Pathwell Specialty Drug List (for employer-sponsored and Individual & Family Plans) with preferred covered alternatives, and lists recently FDA-approved medications under P&T review including whether administration requires a Pathwell Specialty participating provider and affected plans.

Policy Summary

PayerCigna

PolicyCigna Pathwell Specialty Drug List (non-covered medications and recent FDA approvals)

Policy CodePolicy 989959 HCP 2026 Pathwell Specialty

Change TypeNo material change

Effective Date

Next Review Date

Key ActionMost specialty medications require precertification and some require administration by a Pathwell Specialty participating provider; request a medical necessity coverage review if a preferred medication is not appropriate.

POLICY UPDATE CHANGES

No material clinical or coverage changes were made in this update.

100+Non-covered medications listed

12Medications under P&T review

Coverage Summary & Review Process

This document lists specialty medications that are not covered on the Cigna Pathwell Specialty Drug List for both Employer-sponsored and Individual & Family Plans and provides the preferred covered alternatives that treat the same conditions. It also identifies certain recently FDA-approved medications that are currently under review by the Cigna Healthcare Pharmacy and Therapeutics Committee (P&T) for possible addition to the Pathwell Specialty Drug List. If a preferred medication is not appropriate, the prescriber or office may request a medical necessity (coverage) review. Last review: 2026-05-26.

Non‑covered Medications and Preferred Alternatives

Non-covered medications (Employer-sponsored plans) - listed drug names with preferred alternativesmixedNot Covered

ACTEMRA IV	Preferred Medications = AVTOZMA, TYENNE IV
ALYGLO	Preferred Medications = BIVIGAM, FLEBOGAMMA DIF, GAMMAGARD LIQUID, GAMMAKED, GAMMAPLEX, GAMUNEX-C, OCTAGAM, PANZYGA, PRIVIGEN
ALYMSYS	Preferred Medications = MVASI, ZIRABEV
APHEXDA	Preferred Medications = plerixafor
ARALAST NP	Preferred Medications = GLASSIA, PROLASTIN C
ASCENIV	Preferred Medications = BIVIGAM, FLEBOGAMMA DIF, GAMMAGARD LIQUID, GAMMAKED, GAMMAPLEX, GAMUNEX-C, OCTAGAM, PANZYGA, PRIVIGEN
AVASTIN	Preferred Medications = MVASI, ZIRABEV
AVGEMSI	Preferred Medications = generic gemcitabine
BEIZRAY	Preferred Medications = docetaxel
BEIZRAY-ALBUMIN	Preferred Medications = docetaxel

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Non-covered medications (Individual & Family Plans) - listed drug names with preferred alternativesmixedNot Covered

ACTEMRA IV	Preferred Medication(s) = AVTOZMA, TYENNE IV
ALYGLO	Preferred Medication(s) = BIVIGAM, FLEBOGAMMA DIF, GAMMAGARD LIQUID, GAMMAKED, GAMMAPLEX, GAMUNEX-C, OCTAGAM, PANZYGA, PRIVIGEN
ALYMSYS	Preferred Medication(s) = MVASI, ZIRABEV
APHEXDA	Preferred Medication(s) = plerixafor
ARALAST NP	Preferred Medication(s) = GLASSIA, PROLASTIN C
ASCENIV	Preferred Medication(s) = BIVIGAM, FLEBOGAMMA DIF, GAMMAGARD LIQUID, GAMMAKED, GAMMAPLEX, GAMUNEX-C, OCTAGAM, PANZYGA, PRIVIGEN
AVASTIN	Preferred Medication(s) = MVASI, ZIRABEV
AVGEMSI	Preferred Medication(s) = generic gemcitabine
BEIZRAY	Preferred Medication(s) = docetaxel
BEIZRAY-ALBUMIN	Preferred Medication(s) = docetaxel

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Recently FDA‑approved Medications Under P&T Review

Medications listed as "recently approved by the U.S. Food & Drug Administration (FDA)" are under review by the Cigna Healthcare Pharmacy and Therapeutics Committee (P&T) to determine coverage on the Cigna Pathwell Specialty Drug List. Each entry for these medications includes the notification date, review completion date, whether administration requires a Pathwell Specialty participating provider, and the affected plans. While the P&T review is in process, providers can request coverage through the coverage review (medical necessity) process.

Recently FDA-approved medications under P&T reviewmixed

LYMPHIR	Cancer; Notification Date = 2025-12-17; Review Completion Date = 2026-06-15; Requires Pathwell Specialty participating provider = Yes; Plans Affected = C, I
EXDENSUR	Asthma; Notification Date = 2026-01-14; Review Completion Date = 2026-07-13; Requires Pathwell Specialty participating provider = Yes; Plans Affected = C, I
ENOBY	Bone Health; Notification Date = 2026-01-21; Review Completion Date = 2026-07-20; Requires Pathwell Specialty participating provider = Yes; Plans Affected = C, I
GAMMAGARD LIQUID ERC	Immunodeficiency; Notification Date = 2026-01-21; Review Completion Date = 2026-07-20; Requires Pathwell Specialty participating provider = Yes; Plans Affected = C, I
XTRENBO	Cancer; Notification Date = 2026-01-21; Review Completion Date = 2026-07-20; Requires Pathwell Specialty participating provider = Yes; Plans Affected = C, I
LUNSUMIO VELO	Cancer; Notification Date = 2026-02-04; Review Completion Date = 2026-08-03; Requires Pathwell Specialty participating provider = Yes; Plans Affected = C, I
QIVIGY	Immunodeficiency; Notification Date = 2026-03-04; Review Completion Date = 2026-08-31; Requires Pathwell Specialty participating provider = Yes; Plans Affected = C, I
AUKELSO	Cancer; Notification Date = 2026-03-18; Review Completion Date = 2026-09-14; Requires Pathwell Specialty participating provider = Yes; Plans Affected = C, I
BOSAYA	Bone Health; Notification Date = 2026-03-18; Review Completion Date = 2026-09-14; Requires Pathwell Specialty participating provider = Yes; Plans Affected = C, I
AVLAYAH	Metabolic; Notification Date = 2026-03-18; Review Completion Date = 2026-10-12; Requires Pathwell Specialty participating provider = Yes; Plans Affected = C, I

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Provider Requirements and Actions

Prior Authorization

Precertification likely required for specialty medications

Most specialty medications under Cigna Pathwell Specialty require precertification to be covered; some also require administration by a Pathwell Specialty participating provider as indicated in the medication listings.

Documentation Required

Medical necessity review for non-covered medications

If a preferred medication is not appropriate for a patient, providers can request a medical necessity (coverage) review to consider approving coverage of a non-covered medication. If the review is denied and the patient fills the medication out-of-network, the cost will not be applied to the plan deductible or out-of-pocket maximum.

Note: If a patient pays for a non-covered medication out-of-network after denial, those costs won’t count toward the plan deductible or out-of-pocket maximum.

Billing Rule

Network pharmacy requirement may apply

Some plan features require use of an in-network pharmacy to receive no cost-share. Using a pharmacy that does not participate in the plan network may mean the prescription is not covered or reimbursement is limited by the plan’s copayment, coinsurance, or deductible requirements.

Using an out-of-network pharmacy may limit reimbursement and can increase patient cost-sharing (copayment, coinsurance, or deductible).

A Pathwell Specialty participating provider is a provider participating in Cigna Pathwell Specialty who is authorized to administer certain specialty medications; some medications on the list require administration by a Pathwell Specialty participating provider as indicated in the medication listings.

Background

Cigna Pathwell Specialty identifies specialty medications that are part of the Cigna Healthcare medical benefit and helps make them more accessible and easier to manage. Many specialty medications listed under Pathwell Specialty require precertification to be covered, and some must be administered by a Pathwell Specialty participating provider. The document enumerates medications that are not covered on the Cigna Pathwell Specialty Drug List and lists preferred alternatives that treat the same conditions. It also notifies providers about recently FDA-approved medications that are under P&T review and explains how to request a coverage (medical necessity) review if a preferred medication is not appropriate.