Metabolic Disorders - Imcivree Drug Quantity Management Policy - Per Days
Cigna drug quantity management policy governing maximum dispensed quantities and coverage criteria for Imcivree (setmelanotide subcutaneous injection) vials for retail and home delivery; approvals are for 1 year when criteria met.
Quantity limits were changed to 9 mL (9 vials) per 28 days at retail and 27 mL (27 vials) per 84 days at home delivery (prior limits 6 mL/18 mL).
Policy updated to reflect existing quantity limits when a product is obtained via home delivery.
Annual revision with no criteria changes noted on 02/07/2024.
Coverage Summary
Cigna drug quantity management policy governing maximum dispensed quantities and coverage criteria for Imcivree (setmelanotide subcutaneous injection) vials for retail and home delivery; approvals are provided for 1 year when criteria are met.
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