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March 2011

POLICY UPDATE

Clinical, Reimbursement, and Administrative Policy Updates

In an effort to help support access to quality care for plan participants, CIGNA routinely reviews clinical, reimbursement and administrative policies, medical coverage positions, and the precertification process and requirements. The following table provides a summary of recent updates. You may also view new and updated policies, prior to implementation on the CIGNA for Health Care Professionals website (www.cignaforhcp.com).

 

Policy Effective Date Update Where to Find Additional Information
Remicade January 1, 2011
  • Remicade is considered non-preferred for new prescriptions only.
  • New users will go through a two-step process with the preferred brands, Enbrel and Humira, before using a non-preferred brand, including Remicade.
  • Precertification continues to be required for Remicade. Health care professionals will be informed of the two-step process to use preferred brands prior to Remicade when precertification is requested.
  • Participants who were using Remicade prior to January 1, 2011 are not affected.
CIGNA for Health Care Professionals website (www.cignaforhcp.com > Resources > Policies & Procedures > Coverage Positions/Criteria > Pharmacy Coverage Policy Index > Remicade)
Precertification Requirement – Injectables May 1, 2011 Added injectable drug codes:
HCPCS Code Description
J9035 Injection, bevacizumab, 10 mg (Avastin)
J9055 Injection, cetuximab, 10 mg (Erbitux)
J1300 Injection, eculizumab, 10 mg (Soliris)
J9303 Injection, panitumumab, 10 mg (Vectibix)
J9310 Injection, rituximab, 100 mg (RituXan)
J9355 Injection, trastuzumab, 10 mg (Herceptin)
CIGNA for Health Care Professionals website (www.cignaforhcp.com > Resources > Clinical Reimbursement Policies and Payment Policies > Precertification Policies)
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