By Counterforce Health Team in Dupixent (dupilumab) —

How to Get Dupixent (dupilumab) Covered by Cigna in Michigan: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Started

To get Dupixent (dupilumab) covered by Cigna in Michigan, you'll need prior authorization through their specialty pharmacy network. The fastest path: (1) Have your doctor submit a PA request via CoverMyMeds or the Cigna provider portal with complete clinical documentation, (2) Set up specialty pharmacy through Accredo if approved, (3) If denied, file an internal appeal within 180 days, then request external review through Michigan DIFS within 127 days. Cigna must respond to PA requests within 72 hours for standard cases, 24 hours for urgent requests.

Table of Contents

  1. Start Here: Verify Your Plan and Find the Right Forms
  2. Prior Authorization Forms and Requirements
  3. Submission Portals and Electronic Options
  4. Fax Numbers and Mailing Addresses
  5. Specialty Pharmacy Setup with Accredo
  6. Support Phone Numbers and What to Ask
  7. Michigan Appeals and External Review Process
  8. When to Update Your Resources

Start Here: Verify Your Plan and Find the Right Forms

Before diving into paperwork, confirm your specific Cigna plan details. Michigan residents may have traditional Cigna coverage or a Priority Health+Cigna partnership plan. Check the back of your insurance card for the correct member services number.

Coverage at a Glance for Dupixent

Requirement What It Means Where to Find It Source
Prior Authorization Required for all indications Cigna PA Policy Cigna Coverage Policy
Formulary Status Specialty tier (varies by plan) Your plan documents Member portal
Step Therapy May require failed conventional treatments PA form criteria section Cigna PA Policy
Quantity Limits Typically 2 injections per 28 days Plan formulary Express Scripts FAQ
Specialty Pharmacy Must use Accredo or approved network Plan documents Cigna specialty guide
Note: Michigan residents with Priority Health+Cigna plans should call 1-800-942-4765 for provider services and PA support.

Prior Authorization Forms and Requirements

Cigna requires comprehensive clinical documentation for Dupixent approval. The specific criteria vary by indication (atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyps, etc.).

Key Documentation Needed

For All Indications:

  • Confirmed diagnosis with ICD-10 codes
  • Clinical notes supporting severity
  • Documentation of prior treatment failures or contraindications
  • Prescriber specialty verification (dermatology, allergy/immunology, pulmonology)

Condition-Specific Requirements:

Atopic Dermatitis:

  • Failed topical therapies (corticosteroids, calcineurin inhibitors)
  • Phototherapy trial (if appropriate)
  • Severity assessment (BSA affected, EASI score if available)

Asthma:

  • Eosinophilic phenotype documentation
  • Failed high-dose inhaled corticosteroids plus LABA
  • Oral corticosteroid dependence history
  • Exacerbation frequency

Chronic Rhinosinusitis with Nasal Polyps:

  • Failed intranasal corticosteroids
  • Prior sinus surgery (if appropriate)
  • Endoscopic findings

Clinician Corner: Medical Necessity Letter Checklist

When writing the medical necessity letter, include:

✓ Patient's specific diagnosis with ICD-10 codes
✓ Prior treatments tried with dates, dosages, and outcomes
✓ Why alternatives won't work (contraindications, intolerances, failures)
✓ Clinical rationale for Dupixent specifically
✓ Dosing plan and monitoring approach
✓ Supporting guidelines (FDA labeling, specialty society recommendations)

Submission Portals and Electronic Options

Electronic submission is the fastest and most reliable method for PA requests.

Primary Electronic Options

CoverMyMeds (Recommended)

  • Most streamlined process
  • Real-time status updates
  • Automatic routing to correct payer
  • Access: CoverMyMeds portal

ExpressPAth (Express Scripts/Accredo)

  • Direct submission to specialty pharmacy
  • Integrated with Accredo fulfillment
  • Good for renewals and appeals

Cigna Provider Portal (CignaforHCP.com)

  • Upload supporting documents (max 35 MB total, 10 MB per file)
  • Track authorization status
  • Access: CignaforHCP.com

File Upload Requirements

When uploading clinical documentation:

  • Accepted formats: PDF, JPEG, PNG, BMP, GIF, TIF
  • Maximum 6 files per submission
  • File names must be 128 characters or less
  • Include: office notes, lab results, imaging reports, prior therapy records

Fax Numbers and Mailing Addresses

While electronic submission is preferred, fax and mail options remain available for specific situations.

Key Contact Information

Prior Authorization Fax:

  • Verify current number through Cigna PA line: 1-800-244-6224
  • Always use the fax number on the most recent PA form

Mailing Address for Documentation:

Cigna Healthcare Claims
PO Box 5200
Scranton, PA 18505

Cover Sheet Requirements:

  • Patient name, DOB, and Cigna ID
  • Prescriber name and NPI
  • "SPECIALTY PHARMACY PRIOR AUTHORIZATION" header
  • Mark "URGENT" if time-sensitive
  • List all attached documents
Tip: Always request fax confirmation and keep copies of all submitted materials.

Specialty Pharmacy Setup with Accredo

Once your PA is approved, you'll need to transfer your prescription to Cigna's specialty pharmacy network, typically Accredo.

Step-by-Step Setup Process

  1. Receive PA approval notification from Cigna
  2. Call Accredo at 1-800-351-3616 to initiate setup
  3. Provide insurance and prescription information
  4. Complete patient enrollment forms
  5. Schedule delivery (usually within 2-3 business days)
  6. Receive clinical counseling call from Accredo pharmacist

What Accredo Will Need

  • Cigna member ID and group number
  • Prescription from your doctor
  • Shipping address and preferred delivery time
  • Emergency contact information
  • Refrigeration confirmation (Dupixent requires refrigeration)

For clinical support or questions about your therapy, call Accredo's specialty counseling line at 1-844-516-3319.

Support Phone Numbers and What to Ask

Having the right phone numbers can save hours of frustration. Here's who to call for different situations:

Member Services

Cigna Customer Service: 1-800-882-4462

  • Check PA status
  • Verify benefits and coverage
  • Request appeals forms
  • General plan questions

Priority Health (Michigan Cigna partnership): 1-800-942-4765

  • Michigan-specific plans
  • Provider services
  • Case management

Provider Services

Cigna Prior Authorization: 1-800-244-6224

  • PA status checks
  • Expedited review requests
  • Forms and documentation questions

Accredo Provider Services: 1-800-351-3616

  • Prescription transfers
  • Clinical questions
  • Delivery scheduling

Scripts for Common Calls

When calling for PA status: "I'm calling to check the status of a prior authorization for Dupixent for patient [name], member ID [number], submitted on [date]. Can you tell me if additional documentation is needed?"

When requesting expedited review: "I need to request an expedited prior authorization review for Dupixent. The patient's condition requires urgent treatment, and I have clinical documentation supporting the medical necessity."

Michigan Appeals and External Review Process

If Cigna denies your Dupixent PA, Michigan law provides strong appeal rights through a structured process.

Appeals Timeline and Process

Internal Appeals (Cigna):

  • Deadline: 180 days from denial notice
  • Standard review: 30 days for decision
  • Expedited review: 72 hours (with physician letter)
  • How to file: Written request to address on denial letter

External Review (Michigan DIFS):

  • Deadline: 127 days after final internal denial
  • Standard review: 60 days maximum
  • Expedited review: 72 hours (urgent cases)
  • How to file: DIFS External Review Form online or by mail

Required Documentation for Appeals

✓ Copy of original denial letter
✓ Medical necessity letter from prescriber
✓ Clinical notes and test results
✓ Peer-reviewed literature supporting use
✓ FDA labeling information
✓ Specialty society guidelines (if applicable)

Important: Michigan's 127-day deadline for external review is longer than the federal 120-day standard, giving you extra time to prepare a strong appeal.

When to Contact Michigan DIFS

If you encounter any of these issues, contact Michigan Department of Insurance and Financial Services:

  • Cigna fails to respond within required timeframes
  • Denial appears to contradict their own coverage policy
  • Pattern of inappropriate denials
  • Procedural violations in the review process

Michigan DIFS Contact:

Common Denial Reasons and How to Fix Them

Understanding why Dupixent gets denied can help you build a stronger initial request or appeal.

Denial Reason How to Overturn Key Documentation
Insufficient diagnosis documentation Submit detailed clinical notes with ICD-10 codes Specialist consultation notes, severity assessments
Missing step therapy Document prior treatment failures with dates and outcomes Pharmacy records, clinical notes showing inadequate response
Lack of specialist involvement Get referral to appropriate specialist Dermatology, allergy/immunology, or pulmonology consultation
Inadequate severity documentation Provide objective severity measures BSA calculations, EASI scores, exacerbation frequency
Missing safety screenings Complete required testing TB screening, helminth testing, hepatitis B status

Costs and Patient Assistance

Even with insurance approval, Dupixent can be expensive. The list price is approximately $3,993 per carton (two injections), but most patients pay significantly less.

Manufacturer Support Programs

Dupixent MyWay:

  • Copay assistance for eligible patients
  • May reduce out-of-pocket costs to $10 per prescription
  • Eligibility restrictions apply (not available for government insurance)
  • Information: dupixent.com/support-savings

Additional Resources

  • Patient Advocate Foundation: Financial assistance for chronic disease medications
  • NeedyMeds: Database of patient assistance programs
  • GoodRx: Discount programs (limited effectiveness for specialty drugs)

When Coverage Appeals Need Professional Help

While many patients successfully navigate the appeals process independently, some situations benefit from professional assistance. Counterforce Health specializes in turning insurance denials into targeted, evidence-backed appeals by analyzing denial letters, plan policies, and clinical notes to craft point-by-point rebuttals aligned with each payer's specific requirements.

Their platform identifies the exact denial basis—whether it's PA criteria, step therapy requirements, or "not medically necessary" determinations—and pulls the right evidence from FDA labeling, peer-reviewed studies, and specialty guidelines. For complex cases or repeated denials, this type of specialized support can significantly improve approval odds while saving clinicians valuable time.

Update Cadence: Keeping Your Resources Current

Insurance policies and procedures change regularly. Here's how often to check for updates:

Monthly: PA form versions and submission requirements
Quarterly: Formulary status and coverage criteria
Annually: Appeals procedures and state regulations
As needed: Phone numbers and portal access (when you encounter issues)

Key Resources to Bookmark:

Frequently Asked Questions

How long does Cigna prior authorization take in Michigan?
Standard requests: 72 hours. Urgent requests: 24 hours. If Cigna doesn't respond within these timeframes, the request is considered approved.

What if Dupixent is non-formulary on my plan?
Your doctor can request a formulary exception by demonstrating medical necessity and providing clinical rationale for why formulary alternatives are inappropriate.

Can I request an expedited appeal in Michigan?
Yes, both Cigna internal appeals and Michigan DIFS external reviews offer expedited pathways (72 hours) when delays would harm the patient's health.

Does step therapy apply if I tried treatments outside Michigan?
Yes, prior treatment history from other states counts toward step therapy requirements. Provide documentation from all previous providers.

What happens if my appeal is denied?
After exhausting Cigna's internal appeals, you can request external review through Michigan DIFS. Their decision is binding on the insurer.

Sources and Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Always consult with your healthcare provider and insurance plan documents for the most current coverage requirements and procedures. Coverage decisions are ultimately made by your insurance plan based on your specific policy terms and clinical circumstances.

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