Antiemetics – Serotonin Receptor Antagonists (Oral and Transdermal) Drug Quantity Management - Per Rx - (CNF189)
Drug Quantity Management policy for oral and transdermal serotonin (5-HT3) receptor antagonists (granisetron and ondansetron products) administered under Cigna health benefit plans; defines per-prescription retail and home-delivery maximum quantities, exceptions (medical overrides), approval durations, and automation for cancer-related chemotherapy claims.
Throughout the policy, the wording 'nausea and vomiting' was modified to 'nausea and/or vomiting'.
Automation added: prior 180-day prescription claim for a cancer medication (Appendix A list) or cancer ICD-10 codes (Appendix B) will adjudicate to generate approval.
Ondansetron 16 mg orally disintegrating tablets new quantity limits of 2 tablets retail and 6 tablets home delivery were added in a prior revision.
Brand Zofran 4 mg and 8 mg tablets, Ondansetron 24 mg tablets, Zuplenz 4 mg and 8 mg soluble films were removed as obsolete in a prior revision; generics remain.
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.