Complement Inhibitors - Ultomiris
Defines prior authorization, medical necessity criteria, dosing, and coverage limitations for Ultomiris (ravulizumab-cwvz) for Cigna-administered health benefit plans; applies to providers prescribing for aHUS, gMG, NMOSD, and PNH.
Policy title updated from 'Ravulizumab-cwvz Intravenous' to 'Complement Inhibitors - Ultomiris'.
Documentation requirements were updated throughout the policy.
Approval duration for Atypical Hemolytic Uremic Syndrome updated from 6 months to 1 year.
Removed exclusion text referencing diagnosis of TTP (normal ADAMTS13) and trial of plasma exchange as exclusion.
Removed prior requirement stating patients must have been vaccinated against meningococcal infection.
PNH diagnostic criterion changed to require GPI-AP absence/deficiency on at least two cell lineages by peripheral blood flow cytometry.
Dosing recommendations were clarified and split for initial therapy versus patients currently receiving eculizumab to align with prescribing information.
Imaavy added to examples of neonatal Fc receptor blockers in the 'Conditions Not Covered' note.
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.