By Counterforce Health Team in Signifor / Signifor LAR (pasireotide) —

How to Get Signifor LAR (Pasireotide) Covered by Cigna in Florida: Appeals, Prior Authorization & Cost Assistance

Answer Box: Getting Signifor LAR Covered by Cigna in Florida

Fastest path to approval: Submit prior authorization through CoverMyMeds or EviCore portal with complete endocrine labs (UFC for Cushing's, IGF-1 for acromegaly), specialist prescriber documentation, and evidence of prior therapy failures. Cigna classifies Signifor LAR as Tier 4 specialty requiring Accredo specialty pharmacy dispensing. If denied, you have 180 days for internal appeal, then external review through Florida Department of Financial Services. Start today: Call Cigna at (800) 882-4462 to confirm current PA requirements and begin the electronic submission process.

Table of Contents

  1. Understanding Cigna's Coverage Requirements
  2. Step-by-Step Prior Authorization Process
  3. Required Clinical Documentation
  4. Cost Assistance and Savings Options
  5. Appeals Process for Denials
  6. Florida-Specific Appeal Rights
  7. Common Scripts and Communication Tips
  8. FAQ: Cigna and Signifor LAR in Florida

Understanding Cigna's Coverage Requirements

Signifor LAR (pasireotide) is classified as a Tier 4 specialty medication on Cigna's formulary, placing it in the highest cost-sharing category. This somatostatin analog requires prior authorization and must be dispensed through Cigna's specialty pharmacy network, typically Accredo.

Coverage at a Glance

Requirement Details Where to Find Source
Prior Authorization Required Cigna provider portal or CoverMyMeds Cigna PA Guide
Formulary Tier Tier 4 (specialty) Plan formulary document Cigna Formulary
Specialty Pharmacy Accredo required Member benefits or call Accredo PA
Appeal Deadline 180 days from denial Denial letter or EOB Florida DFS
External Review 4 months after final denial Florida Department of Financial Services Florida Appeals Process

Step-by-Step Prior Authorization Process

1. Gather Required Documentation

Who does it: Prescribing endocrinologist and staff
Timeline: 1-2 business days
Documents needed:

  • Complete medical records with diagnosis codes
  • Laboratory results (UFC for Cushing's, IGF-1 for acromegaly)
  • Documentation of prior therapy failures or contraindications
  • Prescriber attestation of medical necessity

2. Submit Electronic Prior Authorization

Who does it: Provider or authorized staff
Timeline: Same day submission
Preferred methods:

3. Cigna Review Process

Timeline: Up to 15 business days
What happens: Clinical pharmacist reviews against coverage criteria
Decision notification: Within 72 hours of review completion

4. If Approved: Specialty Pharmacy Coordination

Who does it: Patient and Accredo
Timeline: 2-3 business days
Next steps: Accredo contacts patient for delivery coordination and injection training

Required Clinical Documentation

Clinician Corner: Medical Necessity Letter Checklist

For Cigna approval, your medical necessity letter must include:

For Cushing's Disease:

  • Confirmed pituitary adenoma via MRI
  • Elevated 24-hour urinary free cortisol (UFC) levels
  • Documentation that surgery is not an option or was not curative
  • Clinical symptoms and impact on quality of life

For Acromegaly:

  • Elevated age-adjusted IGF-1 levels
  • Growth hormone levels >1.0 mcg/L
  • Documentation of inadequate control with surgery and/or first-generation somatostatin analogs
  • MRI evidence of pituitary adenoma

Supporting Evidence:

  • FDA prescribing information for approved indications
  • Endocrine Society clinical practice guidelines
  • Prior therapy documentation with specific drugs, doses, and duration

Cost Assistance and Savings Options

Manufacturer Support Program

Recordati Rare Diseases offers the R.A.R.E. Patient Support Program with significant cost assistance:

  • $20 copay for eligible patients with commercial insurance
  • Patient assistance program for uninsured/underinsured
  • Home injection services at no additional cost
  • Prior authorization and appeals support

Contact: 1-888-855-RARE (7273), Monday-Friday 8 AM-8 PM ET

Additional Financial Resources

Patient Advocate Foundation Financial Aid Funds
One-time grants of $500-$2,000 for treatment-related expenses
Apply: Call 844-216-7520 or register online at patientadvocate.org

Florida Rare Disease Resources
While specific medication grants weren't identified in our research, Florida's Rare Disease Advisory Council maintains resources for patients. Contact the Florida Department of Health for current assistance programs.

Appeals Process for Denials

Common Denial Reasons & Solutions

Denial Reason How to Overturn Required Documentation
Lack of specialist prescriber Endocrinologist consultation Board certification verification
Insufficient lab documentation Complete endocrine workup UFC, IGF-1, GH levels with reference ranges
Step therapy not completed Medical contraindication Allergy documentation or failure notes
Not medically necessary Enhanced clinical narrative Symptom severity, functional impact

Internal Appeal Process

Timeline: Must file within 180 days of denial
Review period: 60 days for Cigna decision
Required documents:

  • Cigna appeal form
  • Original denial letter and EOB
  • Enhanced medical records
  • Updated clinical narrative
  • Supporting literature citations

Submit via: Cigna provider portal or mail to address on denial letter

Note: A physician not involved in the original decision will review all medical necessity appeals.

Florida-Specific Appeal Rights

Florida residents have robust appeal protections under state and federal law:

External Review Process

If Cigna denies your internal appeal, you can request independent external review:

Expedited Reviews

For urgent medical situations:

  • Timeline: 72 hours for external review decision
  • Eligibility: Life-threatening condition or significant health deterioration risk
  • Process: Can request expedited internal and external review simultaneously

State Consumer Assistance

Florida Insurance Consumer Helpline: 1-877-MY-FL-CFO (1-877-693-5236)
Online complaints: Submit through Florida DFS website

Common Scripts and Communication Tips

Patient Script for Cigna Customer Service

"I'm calling about prior authorization for Signifor LAR, prescribed by my endocrinologist for [Cushing's disease/acromegaly]. Can you confirm the current PA requirements and provide the fastest electronic submission method for my doctor's office? I also need to verify this goes through Accredo specialty pharmacy."

Provider Script for Peer-to-Peer Review

"I'm requesting peer-to-peer review for Signifor LAR denial. This patient has [specific diagnosis] with documented [lab values] and has [failed/contraindicated] standard therapies. The denial cited [specific reason], but our clinical documentation clearly demonstrates medical necessity per FDA labeling and Endocrine Society guidelines."

Pharmacy Coordination Tips

When working with Counterforce Health, patients and providers can streamline the appeals process by having all denial documentation and clinical evidence organized upfront. The platform specializes in turning insurance denials into targeted, evidence-backed appeals that align with each plan's specific requirements.

FAQ: Cigna and Signifor LAR in Florida

Q: How long does Cigna prior authorization take in Florida?
A: Standard review is 15 business days, with decision notification within 72 hours of completion. Electronic submission through CoverMyMeds often provides faster processing.

Q: What if Signifor LAR is non-formulary on my plan?
A: Request a formulary exception with enhanced clinical documentation. Cigna must review non-formulary requests when medically necessary and no formulary alternatives are appropriate.

Q: Can I request expedited review for urgent situations?
A: Yes, if your condition is life-threatening or you risk significant health deterioration. Contact Cigna immediately at (800) 882-4462 for expedited processing.

Q: Does step therapy apply if I failed therapies outside Florida?
A: Medical records from any location are valid. Document specific drugs tried, doses, duration, and reasons for discontinuation or failure.

Q: What's the difference between internal and external appeal in Florida?
A: Internal appeals are reviewed by Cigna staff; external appeals are reviewed by independent medical experts assigned by Florida DFS. External review decisions are binding on Cigna.

Q: Can I use GoodRx or discount cards with Cigna coverage?
A: Specialty medications like Signifor LAR typically cannot use discount cards when insurance is billed. However, the manufacturer's R.A.R.E. program offers $20 copays for eligible commercial insurance patients.

Q: How often do I need to renew prior authorization?
A: Typically annually, but Cigna may require 6-month renewals initially. Start renewal requests 30-45 days before expiration to prevent treatment gaps.

Q: What if my endocrinologist is out-of-network with Cigna?
A: Request a single case agreement or network gap exception. Rare disease specialists may qualify for coverage when no in-network alternatives exist.

This guide provides general information about insurance coverage and appeals processes. It is not medical advice. For specific coverage questions, contact Cigna directly. For assistance with complex appeals, organizations like Counterforce Health specialize in converting insurance denials into successful, evidence-based appeals.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Coverage policies and procedures may change. Always verify current requirements with your insurer and consult healthcare professionals for medical decisions.

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