Prednisone Delayed Release Products Step Therapy Policy
Cigna coverage policy that requires trial of immediate-release prednisone (Step 1) before covering delayed-release prednisone products (Step 2) for members of applicable Cigna health benefit plans.
No material clinical or coverage changes in this revision.
Coverage Criteria
Initial Therapy — Covered when ALL of the following are met
Covered when ALL of the following are met
If met, approve a Step 2 product for 1 year
Any use of a Step 2 product (prednisone delayed release tablets, generic, or Rayos brand) without meeting the required step therapy criteria is considered not medically necessary. Coverage for Step 2 products is contingent on satisfying the Step Therapy rule at the point of service; approvals when criteria are met are provided for 1 year.
Any exception that results in use of a Step 2 product without a documented trial of a Step 1 product (prednisone immediate release tablets, generic) is considered not medically necessary. The policy explicitly states that uses outside the step therapy criteria are not covered.
Initial Therapy Criteria
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