CurrentCignaPolicy IP0100

Erectile Dysfunction - Avanafil

Defines medical necessity, step-therapy, quantity limits, initial and reauthorization criteria, and exclusion of non-covered uses for avanafil (Stendra) for treatment of erectile dysfunction for Cigna-administered health benefit plans. Coverage may vary by specific customer benefit plan and some plans exclude sexual dysfunction therapies.

Policy Summary

PayerCigna

PolicyErectile Dysfunction - Avanafil

Policy CodePolicy IP0100

Change TypeAnnual Revision

Effective DateFeb 1, 2025

Next Review Date

Key ActionObtain and document failure, contraindication, or intolerance to two of sildenafil, tadalafil, or vardenafil when plan requires step therapy; obtain prior authorization as required by the customer's benefit plan.

POLICY UPDATE CHANGES

Policy title updated from 'Erectile Dysfunction - Stendra' to 'Erectile Dysfunction - Avanafil' and generic avanafil was added where relevant.

2Step-therapy failures required

8Maximum quantity allowed

12 moInitial authorization duration

12 moReauthorization duration

Coverage Summary

Coverage stance: covered_with_criteria for Avanafil (Stendra) for erectile dysfunction administered under Cigna‑administered health benefit plans. Scope: Defines medical necessity, step‑therapy, quantity limits, initial and reauthorization criteria, and exclusion of non‑covered uses. Subject: Avanafil (Stendra) for erectile dysfunction. Payer: Cigna Companies / health benefit plans administered by Cigna. Coverage varies by customer benefit plan and some plans specifically exclude sexual dysfunction therapies; benefits are determined by the applicable plan document.

Policy dates & identifiers

Effective date2025-02-01

Last review2024-05-01

Next review

Policy numberIP0100

StatusCURRENT