CurrentCignaPolicy N/A

Antiplatelets -Ticagrelor Step Therapy Policy

Cigna step therapy policy requiring use of a Step 1 product (generic ticagrelor tablets) prior to coverage of a Step 2 product (Brilinta/ticagrelor brand) for covered health benefit plans administered by Cigna companies. Approvals are provided for one year.

Policy Summary

PayerCigna

PolicyAntiplatelets -Ticagrelor Step Therapy Policy

Policy CodePolicy N/A

Change TypeNew policy

Effective Date

Next Review Date06/04/2025

Key ActionCoverage for Brilinta (Step 2) requires documentation that the patient has tried one Step 1 product (generic ticagrelor tablets); if the Step Therapy rule is not met at point of service, coverage will be determined by the step therapy criteria.

SourceLink

POLICY UPDATE CHANGES

New Policy created with review date 06/04/2025 (policy content establishes step therapy: Step 1 = generic ticagrelor, Step 2 = Brilinta).

2Step Levels (Step 1 and Step 2)

12 monthsApproval Duration

Coverage Summary

Step 1: generic ticagrelor tablets. Step 2: Brilinta (ticagrelor).

Step Therapy / Initial Coverage Criteria

ALL of the following

The prescriber documents that the patient has tried and failed, had an inadequate response to, or is intolerant to one Step 1 Product (generic ticagrelor tablets).
If the patient has tried one Step 1 Product, approve a Step 2 Product.
The requested Step 2 Product is Brilinta (ticagrelor).

Provider Actions

Step Therapy

Step therapy requirement / prior authorization

Coverage for Brilinta (Step 2) requires documentation that the patient has tried one Step 1 product (generic ticagrelor tablets); if the Step Therapy rule is not met at point of service, coverage will be determined by the step therapy criteria.

Documentation that patient tried one Step 1 product

Documentation Required

Approval duration

All approvals are provided for 1 year in duration; documentation should support prior trial of Step 1 product.

Approvals provided for 1 year

Clinical Evidence

Evidence: Prescribing information — Brilinta prescribing information, AstraZeneca, November 2024.

From the policy overview: Brilinta is a P2Y12 platelet inhibitor whose efficacy was established as superior to clopidogrel for at least the first 12 months following acute coronary syndrome (ACS).

Background & Definitions

Brilinta (ticagrelor) is a P2Y12 platelet inhibitor indicated to reduce the risk of cardiovascular death, myocardial infarction (MI), and stroke in patients with acute coronary syndromes (ACS) or a history of MI; it also reduces risk of stent thrombosis after PCI for ACS and is indicated to reduce risk of stroke in select patients with acute ischemic stroke or high‑risk TIA. The policy notes that for at least the first 12 months following ACS, Brilinta is superior to clopidogrel. As a step therapy policy, Cigna requires trial of a Step 1 product (generic ticagrelor tablets) before covering Step 2 (Brilinta).

Term	Definition
Step 1 Product	generic ticagrelor tablets
Step 2 Product	Brilinta (brand ticagrelor tablets)