Vitamin B12 (Cyanocobalamin) Products Step Therapy Policy
Defines step therapy requirements for coverage of cyanocobalamin injection and cyanocobalamin nasal spray (Nascobal/generic) for Cigna-administered health benefit plans.
No material clinical or coverage changes in this revision.
Coverage Criteria
Initial Step Therapy
Covered when ALL of the following are met
If met, approve Step 2 product (cyanocobalamin nasal spray) for up to 1 year
Any use that does not meet the Step Therapy requirement described in this policy is considered not medically necessary. The policy requires trial of a Step 1 product (cyanocobalamin injection) before use of a Step 2 product (cyanocobalamin nasal spray). Coverage determinations for Step 2 products that do not meet the rule at point of service will be made according to the Step Therapy criteria; all approvals, when granted, are for 1 year in duration.
Exceptions that would allow starting therapy at Step 2 (i.e., initiating treatment with cyanocobalamin nasal spray without a prior trial of cyanocobalamin injection) are considered not medically necessary unless an approved exception is documented per the Step Therapy criteria. The program is specifically designed to encourage use of a Step 1 product prior to Step 2, and any deviation from that sequence must meet the exception process to be covered.
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