Fenofibrate Step Therapy Policy
Step therapy coverage policy for fenofibrate and fenofibric acid products under Cigna-administered health benefit plans; governs prior authorization/coverage sequencing for providers and pharmacy benefit managers.
No material clinical or coverage changes in this revision.
Coverage Criteria — Fenofibrate Step Therapy
Initial Therapy / Step Therapy
Fenofibrate Step Therapy Policy product(s) is(are) covered as medically necessary when the following step therapy criteria is(are) met. Any other exception is considered not medically necessary.
Approvals are provided for 1 year
Any use that does not meet the Step Therapy criteria for Step 2 fenofibrate/fenofibric acid products is considered not medically necessary. The policy requires that a patient must have a documented trial of a Step 1 product before a Step 2 product will be approved; approvals granted under the Step Therapy program are for 1 year in duration.
Exceptions to the Step Therapy requirement—specifically any use of a Step 2 product without documentation of a trial of a Step 1 product—are considered not medically necessary. If the Step Therapy rule is not met at the point of service, coverage will be determined by the Step Therapy criteria in this policy.
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