CurrentCignaPolicy N/A

Topical Corticosteroids - Flurandrenolide Drug Quantity Management Policy - Per Days

Defines drug quantity limits and authorization criteria for topical flurandrenolide products for Cigna-administered health benefit plans, including retail and home delivery maximums and when additional quantities may be approved.

Policy Summary

PayerCigna

PolicyTopical Corticosteroids - Flurandrenolide Drug Quantity Management Policy - Per Days

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateMar 3, 2025

Key ActionSubmit prior authorization requests with appropriate diagnosis codes and documentation to request additional quantities per the Drug Quantity Management criteria; approvals are granted for up to 1 year.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

120 gCordran retail max /30d

360 gCordran home-delivery /90d

180 gFlurandrenolide cream/ointment max

240 mLFlurandrenolide lotion max

1 yearApproval duration

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Criteria

Approval for additional quantities (per product-specific rules)

Covered when ALL of the following are met:

General requirement: Patient is using the product for an FDA-approved indication

From criteria intro

Cordran 0.025% cream - approve additional quantity when: Patient needs to treat greater than 8% of body surface area; approve requested quantity not to exceed 240 grams per 30 days retail or 720 grams per 90 days home delivery>8% BSA; <=240 g/30 days retail; <=720 g/90 days home delivery

Cordran 0.025% cream - approve additional quantity when: Patient needs to administer medication more frequently than two times daily; approve requested quantity not to exceed 240 grams per 30 days retail or 720 grams per 90 days home delivery>2 times daily; <=240 g/30 days retail; <=720 g/90 days home delivery

Flurandrenolide 0.05% cream or ointment - approve additional quantity when: Patient needs to treat greater than 8% of body surface area; approve requested quantity not to exceed 180 grams per 30 days retail or 540 grams per 90 days home delivery>8% BSA; <=180 g/30 days retail; <=540 g/90 days home delivery

Flurandrenolide 0.05% cream or ointment - approve additional quantity when: Patient needs to administer medication more frequently than two times daily; approve requested quantity not to exceed 180 grams per 30 days retail or 540 grams per 90 days home delivery>2 times daily; <=180 g/30 days retail; <=540 g/90 days home delivery

Flurandrenolide lotion 0.05% - approve additional quantity when: Patient needs to treat greater than 8% of body surface area or is administering more frequently than two times daily; approve requested quantity not to exceed 240 mL per 30 days retail or 720 mL per 90 days home delivery>8% BSA or >2 times daily; <=240 mL/30 days retail; <=720 mL/90 days home delivery

No overrides are recommended for use in compounded formulations.

Any quantity requests that do not meet the stated Drug Quantity Limits or the approval criteria are considered not medically necessary.

Coding

Body surface area coverage threshold

ThresholdGreater than 8% of body surface area (BSA) — used to approve increased quantities for flurandrenolide products

Use caseApplies when patient needs to treat >8% BSA to permit higher retail or home delivery limits per product-specific rules

Relation to dosing frequencyThreshold can be met alternatively by need for administration >2 times daily; either condition may justify increased quantities

Provider Actions & Billing

Documentation Required

Billing and documentation

Providers must submit requests consistent with the member's applicable benefit plan. Use the most appropriate and current diagnosis and procedure codes for the date of service. Claims submitted for services that are not accompanied by covered diagnosis and/or procedure codes under the applicable benefit plan will be denied as not covered. Medical documentation supporting medical necessity (including relevant clinical notes, body surface area treated, dosing frequency, and quantity requested) should be included with prior authorization requests and retained in the medical record for claim audit. Providers should follow any additional client-specific billing or coding instructions when applicable.

Use current, most-appropriate diagnosis and procedure codes as of the submission date
Include clinical documentation supporting medical necessity (e.g., % body surface area, dosing frequency, prior treatments)
Retain supporting records and include them with prior authorization requests as requested

Background

Flurandrenolide topical formulations are indicated for inflammatory and pruritic manifestations of corticosteroid‑responsive dermatoses, including moderate to severe plaque psoriasis. Moderate to severe psoriasis often involves larger body surface areas (commonly >5–10% BSA) or critical sites where topical treatment over extensive areas may be required or impractical compared with phototherapy or systemic agents.

Definitions

Fingertip unit (FTU)

DefinitionFingertip unit (FTU): amount squeezed along an adult fingertip ≈0.5 g; used to estimate topical dose

BSA coverage per FTUOne FTU covers approximately 2% of an adult's body surface area

Conversion1 g ≈ 4% of adult BSA (therefore 0.5 g ≈ 2% BSA)

Clinical noteFTU is the standard measure for adults; pediatric coverage varies with child size

Quantity Limits by Product

Cordran 0.025% cream

ProductCordran 0.025% cream (package size: 120 g tube)

Standard retail limit120 grams per 30 days

Availability noteSupplied in 120 gram tubes

Cordran 0.025% cream (home delivery)

ProductCordran 0.025% cream (home delivery)

Standard home delivery limit360 grams per 90 days

CommentHome delivery maximum corresponds to three 120 g tubes per 90 days

Policy Summary

PayerCigna

PolicyTopical Corticosteroids - Flurandrenolide Drug Quantity Management Policy - Per Days

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateMar 3, 2025

SourceLink

On This Page

Billing Rule

Quantity limits and approval duration

The Drug Quantity Management rule enforces maximum retail and home delivery quantities per product. If the rule is not met at point of service, coverage will be determined by the Criteria. Approvals for exceptions are provided for 1 year. Providers requesting quantities above the standard maximums must document the clinical justification (see billing and documentation callout) and request an approval; include proposed quantity, route/formulation, and rationale.

All approvals are provided for 1 year in duration
Documented clinical justification required for quantities exceeding standard maximums

Denial Risk

Denial risk for exceeding quantity limits

If requests or point-of-sale transactions exceed the Drug Quantity Management limits and do not meet the Criteria or lack required documentation, the request will be denied. To reduce denial risk, ensure prior authorization (when required) includes explicit documentation of body surface area treated, dosing frequency, and the specific quantity and supply interval requested.

Denials likely when quantity limits are exceeded without sufficient clinical justification
Provide BSA %, dosing frequency, and exact quantity/supply interval to support exception requests

Flurandrenolide 0.05% cream (60 g tube)

ProductFlurandrenolide 0.05% cream (60 g tube generic / Cordran)

Standard retail/home limits120 grams retail per 30 days; 360 grams home delivery per 90 days

Approved increased limitsUp to 180 grams per 30 days retail or 540 grams per 90 days home delivery when treating >8% BSA or administering >2 times daily

Flurandrenolide 0.05% ointment (60 g tube)

ProductFlurandrenolide 0.05% ointment (60 g tube)

Standard limitsStandard limits described; retail and home delivery maximums apply per policy

Approved increased limitsUp to 180 grams per 30 days retail or 540 grams per 90 days home delivery when treating >8% BSA or administering >2 times daily

Flurandrenolide 0.05% lotion

ProductFlurandrenolide 0.05% lotion (Cordran, Nolix, generic)

Standard retail/home limits120 mL retail per 30 days; 360 mL home delivery per 90 days

Approved increased limitsUp to 240 mL per 30 days or 720 mL per 90 days when treating >8% BSA or administering >2 times daily