Cigna Step Therapy Exception Form
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People also ask
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What is an exception request in health insurance?
An exception request is a type of coverage determination. An enrollee, an enrollee's prescriber, or an enrollee's representative may request a tiering exception or a formulary exception.
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What is considered step therapy for Mounjaro?
Some health insurance providers require step therapy for Mounjaro. This means you may have to try a drug from its preferred medications list before it will cover a non-preferred drug. Before starting Mounjaro treatment, it's important to check your coverage details with your insurance provider.
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Does Cigna require prior authorization for medication?
When your Physician prescribes certain Prescription Drugs or Related Supplies, including high cost and Specialty Medications, Cigna Healthcare requires your Physician to obtain Prior Authorization before the Prescription or supply can be filled.
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What is an example of step therapy?
If a health plan uses step therapy for certain drugs, it means that a patient can be required to try a lower cost prescription drug that treats a given condition before “stepping up” to a similar-acting, but more expensive drug.
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What are the exceptions to step therapy?
Insurers must grant step therapy exception requests if: the required drug is contraindicated, the patient has tried the required drug on their current or previous health plan and the patient's provider submits evidence of failure or intolerance, or if the patient is stable on a drug currently selected by their provider ...
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What would be considered a step therapy exception?
(c) “Step therapy exception” means a decision to override a generally applicable step therapy protocol in favor of coverage of the prescription drug prescribed by a health care provider for an individual insured.
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What is stepwise therapy?
Step therapy is used to ensure you're getting the most reasonably priced and most effective drug available. Step therapy encourages the use of lower-priced medications before “stepping up” to medications that cost more. This helps keep costs down for everyone.
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Is step therapy the same as prior authorization?
Prior authorization is a requirement by the insurance company to approve certain medications or procedures before they can be covered by insurance, while step therapy is a protocol that requires patients to try a less expensive or lower-risk medication before moving on to more expensive or risky treatments.
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