CurrentCignaPolicy IP0091

Progesterone (Vaginal) for Individual and Family Plans

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Defines Cigna's coverage and prior authorization requirements for vaginal progesterone (Endometrin and generics) for Individual and Family Plans, including indications, durations, and exclusions.

Policy Summary

PayerCigna

PolicyProgesterone (Vaginal) for Individual and Family Plans

Policy CodePolicy IP0091

Change TypeMaterial revisions to indications and authorization durations

Effective DateAug 1, 2026

Last ReviewAug 1, 2026

Next Review DateAug 1, 2026

Key ActionObtain prior authorization and submit documentation showing ART-related embryo implantation support or prevention of preterm birth to support coverage.

SourceLink

POLICY UPDATE CHANGES

Infertility indication criterion was updated to require that the medication be used to support embryo implantation and early pregnancy by supplementation of corpus luteal function AND be part of an Assisted Reproductive Technology (ART) treatment program.

Duration of therapy for infertility was increased from 6 months to 9 months.

Duration of therapy for prevention of preterm birth was increased from 6 months to 1 year.

Generic Endometrin vaginal inserts were added to the policy and references to generic products were clarified throughout.

2Approved indication groups

9 mo

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CurrentCignaPolicy IP0091

Progesterone (Vaginal) for Individual and Family Plans

Customize your policy alerts

Sign up for Cigna Policy IP0091 alerts

Get alerted when Policy IP0091 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Defines Cigna's coverage and prior authorization requirements for vaginal progesterone (Endometrin and generics) for Individual and Family Plans, including indications, durations, and exclusions.

Policy Summary

PayerCigna

PolicyProgesterone (Vaginal) for Individual and Family Plans

Policy CodePolicy IP0091

Change TypeMaterial revisions to indications and authorization durations

Effective DateAug 1, 2026

Last ReviewAug 1, 2026

Next Review DateAug 1, 2026

Key ActionObtain prior authorization and submit documentation showing ART-related embryo implantation support or prevention of preterm birth to support coverage.

SourceLink

POLICY UPDATE CHANGES

Duration of therapy for infertility was increased from 6 months to 9 months.

Duration of therapy for prevention of preterm birth was increased from 6 months to 1 year.

Generic Endometrin vaginal inserts were added to the policy and references to generic products were clarified throughout.

2Approved indication groups

9 mo

Coverage Criteria

Medically Necessary Indications

Progesterone vaginal insert (Endometrin, generics) is medically necessary when ONE of the following is met (1 or 2):

1) Infertility (FDA-Approved Indication)

A: The medication is to be used to support embryo implantation and early pregnancy by supplementation of corpus luteal function.
B: Use is indicated as part of an Assisted Reproductive Technology (ART) treatment program.

2) Prevention of Preterm Birth (Other use with supportive evidence): Approve for 1 year.N/A

Authorization duration: 1 year

Fertility medications, including products used to support assisted reproduction, are specifically excluded under most benefit plans. Coverage for vaginal progesterone (Endometrin and generics) may therefore vary by member based on the terms of their applicable benefit plan document. Providers should check the member’s plan for benefit availability and any plan‑specific terms and conditions before initiating therapy or submitting a prior authorization request.

Use of progesterone vaginal insert (Endometrin, generics) for any indication other than supporting embryo implantation and early pregnancy as part of an Assisted Reproductive Technology (ART) program or for prevention of preterm birth is considered not medically necessary. The policy will be updated if new published evidence changes these determinations.

Coding

Covered products (examples)mixedCovered

Endometrin (progesterone vaginal insert)

Brand product listed in policy

Prior Authorization & Provider Actions

Prior Authorization

Prior authorization required; approval durations

Prior Authorization is required for benefit coverage of vaginal progesterone. Approvals are provided for the durations specified in the policy: 9 months for ART-related infertility and 1 year for prevention of preterm birth.

Note

Fertility medication benefit exclusion — verify plan terms

Fertility medications are specifically excluded under most benefit plans; confirm benefit availability and any plan terms by reviewing the member's applicable benefit plan document.

Documentation Required

Submit prior authorization with supporting clinical documentation

Background

Vaginal progesterone (e.g., Endometrin and generics) is used clinically to support embryo implantation and early pregnancy by supplementing corpus luteal function. In ART programs this luteal support is provided following procedures such as embryo transfer to promote implantation and maintain early gestation.

Definitions

ART — Definition of Assisted Reproductive Technology (ART) treatment program

DefinitionAssisted Reproductive Technology (ART) treatment program: clinical programs involving procedures such as embryo transfer where luteal support with progesterone is used to support embryo implantation and early pregnancy.

Clinical intentUse of vaginal progesterone to supplement corpus luteal function to support embryo implantation and early pregnancy as part of an ART program.

Typical procedures includedProcedures such as embryo transfer where luteal support with progesterone is administered.

Compounded products — note about compounded progesterone

DefinitionCompounded progesterone products: non–FDA-approved preparations (e.g., compounding kits such as First‑Progesterone VGS 100 mg and 200 mg) used for oral, topical, sublingual, vaginal administration and for injection.

Regulatory status