CurrentCignaPolicy N/A

Calcium Channel Blockers - Dihydropyridine Products Step Therapy Policy

Cigna step therapy program that requires trying preferred (Step 1) dihydropyridine calcium channel blocker products before coverage of specified Step 2 products; applies to health benefit plans administered by Cigna companies.

Policy Summary

PayerCigna

PolicyCalcium Channel Blockers - Dihydropyridine Products Step Therapy Policy

Policy CodePolicy N/A

Change TypeProduct list updates and clarification of approval duration

Effective DateN/A

Next Review DateN/A

Key ActionTry a Step 1 product before requesting approval for a Step 2 product; approvals are granted for 1 year.

SourceLink

POLICY UPDATE CHANGES

Sdamlo was added to Step 2 and to the swallowing-difficulty exception.

Adalat CC was removed from Step 2 because it is no longer available.

All approvals are provided for 1 year in duration.

2 stepstwo-step therapy structure

1 yrapproval duration

3oral solution products approved

multiplelisted DHP CCBs

Coverage Criteria

Step Therapy Criteria

Covered when the following step therapy criteria are met

General Step Therapy: For all agents except Prestalia, approval of a Step 2 product requires that the patient has tried one Step 1 product.1 Step 1 product tried

Approvals issued for 1 year.

Prestalia specific: For Prestalia, approval requires the patient has tried one Step 1 product AND one angiotensin converting enzyme (ACE) inhibitor.1 Step 1 product AND 1 ACE inhibitor tried

Examples of ACE inhibitors include perindopril, enalapril, lisinopril, benazepril. Approvals issued for 1 year.

Swallowing/dysphagia exception:

Policy Summary

PayerCigna

PolicyCalcium Channel Blockers - Dihydropyridine Products Step Therapy Policy

Policy CodePolicy N/A

Change TypeProduct list updates and clarification of approval duration

Effective DateN/A

Next Review DateN/A

Key ActionTry a Step 1 product before requesting approval for a Step 2 product; approvals are granted for 1 year.

SourceLink

On This Page

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Provider Actions and Requirements

Step Therapy

Step therapy prior authorization requirement

Step therapy enforces a requirement to try Step 1 products before Step 2 products. All approvals are granted for 1 year in duration. For Prestalia, the program requires the patient to try one Step 1 Product (a generic DHP CCB or a generic DHP CCB-combination product) AND one angiotensin converting enzyme (ACE) inhibitor prior to approval. If the Step Therapy rule is not met for a Step 2 Product at the point of service, coverage will be determined by the Step Therapy criteria and may result in denial.

Step Therapy approvals duration: 1 year
Prestalia exception: requires one Step 1 Product AND one ACE inhibitor trial (examples: perindopril, enalapril, lisinopril, benazepril)
If Step Therapy rule not met at point of service, coverage determined by Step Therapy criteria and may be denied

Billing Rule

Billing / coding requirement

Providers must bill using the most appropriate and current codes as of the effective date of the submission. Claims for services not accompanied by covered code(s) under the applicable coverage policy will be denied as not covered.

Use current, appropriate CPT/HCPCS/ICD-10/NDC codes effective on date of service
Claims lacking covered codes under the applicable coverage policy will be denied

Denial Risk

Denial triggers

If the Step Therapy rule is not met for a Step 2 product at the point of service, coverage will be determined by the Step Therapy criteria and may result in denial. Providers should confirm prior authorization or meet documented step requirements before dispensing or administering Step 2 agents.

Denial trigger: Failure to meet Step Therapy requirements at point of service
Operational note: For patients with swallowing difficulties, Katerzia, Norliqva, or Sdamlo may be approved without additional Step 1 trials

Definitions

inv-09: Dihydropyridine calcium channel blockers — Key named agents and description

Class nameDihydropyridine (DHP) calcium channel blockers (CCBs)

Primary indicationsTreatment of hypertension in adults (most DHP CCBs); selected agents for chronic stable angina and vasospastic angina; amlodipine indicated in patients ≥6 years and certain CAD contexts

Representative named agentsAmlodipine (Norvasc, generics), Afeditab CR, Conjupri (levamlodipine), felodipine ER, isradipine IR, nicardipine IR, nifedipine (IR/ER/XL; Procardia/Procardia XL), Nifediac CC, Nifedical XL, nisoldipine ER (Sular), amlodipine combinations (amlodipine/atorvastatin, amlodipine/benazepril), Prestalia (perindopril arginine + amlodipine)

Oral solution/suspension agents (swallowing-difficulty option)Katerzia (amlodipine oral suspension), Norliqva (amlodipine oral solution), Sdamlo (amlodipine oral solution)

Notable formulation exceptionsImmediate-release (IR) nifedipine and nimodipine are exceptions in the overview (nimodipine discussed separately for SAH use)

inv-10: Formulation types referenced — Immediate-release (IR), extended-release (ER), oral suspension/solution

Immediate-release (IR)Short-acting oral formulations; examples in policy include isradipine IR, nicardipine IR, nifedipine IR

Extended-release (ER)Modified/extended-release oral formulations for once-daily dosing; examples include felodipine ER, nifedipine ER/XL (Procardia XL)

Oral suspension/solutionLiquid formulations for patients with difficulty swallowing: Katerzia (amlodipine oral suspension), Norliqva (amlodipine oral solution), Sdamlo (amlodipine oral solution)

Step Therapy Operational Rules

Step	Requirement
Step 1	Try one Step 1 product prior to Step 2 approval. Step 1 products: Afeditab CR; amlodipine (including Norvasc, generics); amlodipine/atorvastatin; amlodipine/benazepril; felodipine ER; isradipine IR; nicardipine IR; nifedipine ER, IR, XL; Nifediac CC; Nifedical XL; nisoldipine ER.

Step	Approval / Duration
Step 2 (general)	If the Step 1 requirement is met, approve Step 2 products for 1 year. Step 2 products include: Conjupri (levamlodipine), Katerzia (amlodipine oral suspension), Norliqva (amlodipine oral solution), Norvasc, Procardia / Procardia XL, Sular, and others listed in policy.
Step 2 (Prestalia)	For Prestalia, approve only if the patient has tried one Step 1 product AND one ACE inhibitor (examples: perindopril, enalapril, lisinopril, benazepril). Approval duration: 1 year.
Swallowing/dysphagia exception	If the patient cannot swallow or has difficulty swallowing tablets or capsules, approve Katerzia, Norliqva, or Sdamlo for 1 year.

OpenPayer

Calcium Channel Blockers - Dihydropyridine Products Step Therapy Policy

Coverage Criteria

Provider Actions and Requirements

Definitions

Initial (Step 1) Therapy

Step Therapy Operational Rules

Background