Cigna Prior Authorization Lookup
Latest Cigna prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Inflammatory Conditions - Orencia Intravenous Preferred Specialty Management Policy for Legacy Prescription Drug ListsGoverns prior authorization and preferred-product step therapy rules for Orencia intravenous (abatacept IV) across inflammatory conditions (RA, JIA, PsA) for Cigna-administered plans.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Attention Deficit Hyperactivity Disorder (ADHD) Stimulant Medications for Employer PlansCriteria for medical necessity and prior authorization of stimulant medications for Attention Deficit Hyperactivity Disorder (ADHD) for Cigna employer plans, including brand and generic interchangeability, step therapy, and special formulation considerations.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Attention Deficit Hyperactivity Disorder Non-Stimulant MedicationsDefines Cigna prior authorization, medical necessity, and coverage criteria for non-stimulant ADHD medications Onyda XR (clonidine XR oral suspension) and Qelbree (viloxazine XR capsules) for members covered under Cigna benefit plans.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Cysteamine (Oral) Products for Employer PlansThis policy governs prior authorization and coverage criteria for oral cysteamine products (specifically Procysbi) for treatment of nephropathic cystinosis for employer plans administered by Cigna, including documentation and prescriber specialty requirements.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Dermatology - Vtama Drug Quantity Management Policy - Per DaysDefines quantity limits and exception criteria for coverage of Vtama topical cream for Cigna-administered health benefit plans, affecting prescribers and pharmacy prior authorization processes.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Drugs Requiring Medical Necessity Review for Employer PlansDefines Cigna's medical necessity review requirements for drugs under employer plans and lists product-specific criteria and documentation requirements for prior authorization and coverage determinations.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Glaucoma ProstaglandinsDefines prior authorization and medical necessity criteria for coverage of ophthalmic prostaglandin products to reduce intraocular pressure in patients with open-angle glaucoma or ocular hypertension for Cigna-administered health benefit plans.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Hereditary Angioedema - EkterlyThis policy governs prior authorization and coverage criteria for Ekterly (sebetralstat tablets) for treatment of acute hereditary angioedema (HAE) attacks in members of Cigna-administered health plans.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Imbruvica for Non-Oncology UsesDefines Cigna's prior authorization and medical necessity criteria for coverage of Imbruvica when used for non-oncology indications, primarily chronic graft-versus-host disease, and applies to Cigna-administered health benefit plans.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Infliximab Intravenous Products Preferred Specialty Management PolicyCigna's preferred specialty management program that governs prior authorization and preferred product sequencing for infliximab intravenous products for members covered by Cigna-administered health benefit plans.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Inpefa (sotagliflozin) drug coverageDefines Cigna's coverage and prior authorization requirements for Inpefa (sotagliflozin) for adults to reduce risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits; applies to health benefit plans administered by Cigna Companies unless a client-specific plan document controls.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15KygevviThis policy governs prior authorization and medical necessity criteria for coverage of Kygevvi for treatment of thymidine kinase 2 deficiency (TK2d) under Cigna-administered health benefit plans. It affects prescribers and payers evaluating requests for Kygevvi.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Lumizyme (alglucosidase alfa) — Pompe Disease (acid alpha‑glucosidase deficiency)Defines Cigna's prior authorization, documentation, and clinical criteria for coverage of Lumizyme for patients with Pompe disease (acid alpha-glucosidase deficiency) for health benefit plans administered by Cigna Companies.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Metabolic Disorders - Cysteamine (Oral) Products for Individual and Family PlansDefines prior authorization, coverage criteria, and documentation requirements for Cystagon and Procysbi for members on Cigna Individual and Family Plans for treatment of nephropathic cystinosis.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Multiple Sclerosis (Injectable - CD20-Directed Cytolytic Antibody) - Ocrevus IntravenousDefines prior authorization, coverage criteria, dosing, and exclusions for ocrelizumab (Ocrevus) intravenous infusion for treatment of primary progressive MS and relapsing forms of MS for Cigna-administered plans.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Pharmacy and Medical Prior AuthorizationDefines medical necessity review and prior authorization requirements for drugs requiring pharmacy or medical prior authorization for Cigna-administered Employer Group and Individual and Family Plans, including non-formulary drug exception criteria.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Pombiliti (cipaglucosidase alfa-atga) for Pompe diseaseCigna coverage policy governing prior authorization, medical necessity criteria, dosing, and coding for Pombiliti (cipaglucosidase alfa-atga) used with miglustat (Opfolda) to treat late-onset Pompe disease in adults >40 kg.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Pulmonary Arterial Hypertension Endothelin Receptor AntagonistsDefines Cigna prior authorization, coverage criteria, and medical necessity for ambrisentan, macitentan, macitentan/tadalafil (Opsynvi), and bosentan for pulmonary arterial hypertension and selected other indications.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Somatostatin Analogs - MycapssaCigna's coverage policy for Mycapssa (octreotide delayed-release capsules) specifying prior authorization, prescribing clinician requirements, and medical necessity criteria for treatment of acromegaly in members of Cigna-administered health plans.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Step Therapy - Standard and Performance Prescription Drug Lists (Employer Group Plans)Defines Cigna's step therapy requirements for employer group prescription drug lists (Standard and Performance), including which drugs require prior authorization and conditions for medical necessity determinations for coverage.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Topical Acyclovir ProductsThis policy governs prior authorization and coverage criteria for topical acyclovir products (Zovirax 5% cream and ointment and generics) for Cigna-administered health benefit plans. It affects prescribers and pharmacists seeking coverage for topical acyclovir for members under Cigna plans.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Vafseo (vadadustat) for anemia in CKD on dialysisThis coverage policy governs prior authorization and medical necessity criteria for Vafseo (vadadustat tablets) for treatment of anemia due to chronic kidney disease in adults receiving dialysis, and describes excluded uses. It applies to Cigna-administered health benefit plans as detailed in the policy.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-13Spinal Muscular Atrophy - Gene Therapy ItvismaDefines Cigna coverage, prior authorization, clinical and laboratory criteria, dosing, and exclusions for Itvisma for treatment of spinal muscular atrophy in pediatric and adolescent patients; affects providers who prescribe/administer Itvisma and those submitting claims.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-13Zolgensma (onasemnogene abeparvovec) — Spinal Muscular Atrophy gene therapyCigna coverage policy governing prior authorization, medical necessity criteria, dosing, and documentation for one-time intravenous Zolgensma in patients with spinal muscular atrophy under 2 years of age.All Cigna updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Anticoagulants - Dabigatran (Pradaxa)Coverage, prior authorization, and preferred product criteria for dabigatran (Pradaxa) formulations including capsules and oral pellets for prevention and treatment of thromboembolic conditions for Cigna plans.All Cigna updates
1–25 of 2037
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Tool Description
Search Cignaprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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