Cigna Requirement to Precertify Oncology Medications
December 2017 ~
On February 20th, Cigna implemented an integrated oncology management program which requires providers to precertify certain medical oncology medications through a national ancillary provider.
The program is administered through eviCore healthcare (eviCore), a national ancillary provider. Providers must precertify certain medical oncology medications through eviCore (instead of Cigna), including primary chemotherapy, and supportive drugs, such as medical injectables and infusions.
On June 26th, Cigna expanded the program to include precertification of oral chemotherapy medications. This allows providers to submit one integrated precertification request to eviCore for both the medical and pharmacy medications needed for a planned course of treatment. The insurer states the goal of the program is to ease administrative burden, so that providers may concentrate on providing patients who have Cigna-administered coverage with a coordinated, medically appropriate course of cancer treatment. eviCore will review the patient’s entire treatment plan for coverage, rather than reviewing each medication individually, based on the National Comprehensive Cancer Network® (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines®), and Cigna’s medical oncology coverage policies.
Source(s): Cigna Network News;