CurrentCignaPolicy IP0584

Attention Deficit Hyperactivity Disorder (ADHD) Stimulants for Individual and Family Plans

Cigna drug coverage policy (IP0584) defining medical necessity, preferred-product step therapy, reauthorization, authorization durations, and not-covered uses for specified CNS stimulant products (multiple brand and generic formulations) for individual and family plans.

Policy Summary

PayerCigna

PolicyAttention Deficit Hyperactivity Disorder (ADHD) Stimulants for Individual and Family Plans

Policy CodePolicy IP0584

Change TypeMultiple product additions and preferred-product updates

Effective DateFeb 15, 2026

Next Review Date

Key ActionApproval requires documentation of diagnosis and the specified prior trial(s), failures, contraindications, or intolerances for the requested stimulant product as detailed in product-specific criteria.

POLICY UPDATE CHANGES

Added criteria for dextroamphetamine immediate-release tablets, methylphenidate ER tablets (45mg, 63mg, and 72mg), Relexxii, and Zenzedi.

Added criteria for Metadate CD.

Removed methylphenidate extended-release capsules (generic for Aptensio XR) from the list of alternatives in the preferred product criteria for Metadate CD, methylphenidate ER 45/63/72 mg, and Relexxii.

Added Adzenys XR-ODT and amphetamine extended-release orally disintegrating tablets (generic for Adzenys XR-ODT) to the policy and updated preferred product statements and Vyvanse capsule/chewable preferred product requirements.

MultipleProducts covered (brand and generics)

Up to 12 monthsInitial authorization duration

Up to 12 monthsReauthorization duration