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

How to Get Signifor / Signifor LAR (pasireotide) Approved by Cigna in Washington: Complete Timeline and Appeals Guide

Quick Answer: Getting Signifor Approved by Cigna in Washington

Cigna requires prior authorization for Signifor/Signifor LAR (pasireotide) with 72-hour standard review times in Washington. Your endocrinologist must submit clinical documentation proving medical necessity, including biochemical evidence (elevated UFC for Cushing's or IGF-1 for acromegaly) and justification why surgery isn't viable. Start by gathering your diagnosis codes, lab results, and prior treatment records, then have your specialist submit through Cigna's electronic portal. If denied, Washington's strong appeals framework gives you 180 days for internal appeals and external review with an 82% overturn rate for specialty drugs.

Table of Contents

What Affects Approval Timeline

Several factors determine how quickly Cigna approves your Signifor/Signifor LAR request in Washington:

Benefit Structure: Cigna typically manages Signifor through Express Scripts or Accredo specialty pharmacy, requiring prior authorization regardless of your plan type. The medication sits on the highest specialty tier, meaning substantial cost-sharing once approved.

Clinical Complexity: Cigna's coverage criteria require specific documentation:

  • For Cushing's disease: Elevated urinary free cortisol (UFC), age ≥18, and surgical contraindication
  • For acromegaly: Elevated IGF-1, inadequate surgical response, and prior first-generation somatostatin analog trial

Documentation Completeness: Missing lab values, incomplete prior treatment records, or non-specialist prescribers trigger automatic delays or denials.

Pre-Submission Preparation (0-2 Days)

Essential Documents Checklist

Clinical Records:

  • Recent biochemical evidence (UFC >3x upper limit for Cushing's; elevated age-adjusted IGF-1 for acromegaly)
  • Surgical consultation notes or contraindication documentation
  • Prior medication trials and outcomes (especially octreotide/lanreotide for acromegaly)
  • Complete diagnosis with ICD-10 codes

Administrative Items:

  • Current Cigna member ID and policy details
  • Endocrinologist's NPI and specialty designation
  • Preferred specialty pharmacy information (typically Accredo)
Tip: Schedule lab work 2-3 weeks before your appointment to ensure fresh results for the prior authorization submission.

Submission to Initial Review (1-3 Days)

Washington state law requires Cigna to process electronic prior authorization requests within 72 hours for standard cases and 24 hours for expedited reviews when delays could jeopardize health.

Electronic Submission Routes:

  • CoverMyMeds portal (preferred for fastest processing)
  • Cigna provider portal
  • EHR integration through Surescripts

Your endocrinologist must clearly document:

  • Why Signifor is medically necessary for your specific condition
  • Evidence that surgery is contraindicated, failed, or not curative
  • Baseline biochemical markers requiring treatment

Expedited Review Criteria: Request expedited processing if you're experiencing severe symptoms or if treatment delays could worsen your condition. Include specific clinical urgency documentation.

Additional Information Requests (1-7 Days)

If Cigna requests additional information, respond within 5 business days to avoid restarting the review clock. Common requests include:

  • More detailed surgical consultation notes
  • Additional biochemical testing results
  • Peer-reviewed literature supporting off-label use (if applicable)
  • Specialist attestation of medical necessity
Note: Use Cigna's secure messaging system or designated fax line to submit additional documents. Keep confirmation receipts for all submissions.

Decision Window and Outcomes

Approval: You'll receive a determination letter specifying:

  • Approved duration (typically 12 months initial, renewable annually)
  • Quantity limits and dosing restrictions
  • Required specialty pharmacy (usually Accredo)
  • Cost-sharing tier information

Partial Approval: May include step therapy requirements or quantity limitations that differ from the original request.

Denial: The letter must specify the exact reason and your appeal rights under Washington law.

If Denied: Washington Appeals Process

Washington offers robust consumer protections for insurance denials, with some of the strongest appeals frameworks in the nation.

Internal Appeals (First Step)

  • Timeline: File within 180 days of denial
  • Decision: Cigna must respond within 30 days (72 hours if expedited)
  • Requirements: Submit written appeal with supporting clinical documentation

External Review (Independent Review)

If internal appeals fail, Washington's external review process provides a final determination:

  • Timeline: Request within 180 days of final internal denial
  • Process: Independent Review Organization (IRO) with medical specialists
  • Decision: Binding on Cigna within 30 days (72 hours expedited)
  • Success Rate: 82% overturn rate for specialty drug appeals

Contact Washington Insurance Commissioner: Call 1-800-562-6900 for appeal assistance and guidance through the process.

Renewal Cycles and Maintenance

Initial Approval: Typically 12 months for both Cushing's disease and acromegaly indications.

Renewal Requirements:

  • Documentation of clinical response (normalized or improved UFC/IGF-1 levels)
  • Medication adherence ≥85% (pharmacy records)
  • Ongoing specialist oversight
  • Assessment of side effects and tolerability

Timeline for Renewals: Submit renewal requests 30-45 days before expiration to prevent treatment gaps.

Timeline Visual: Key Milestones

Phase Timeline Action Required Washington Advantage
Pre-submission 0-2 days Gather documentation Strong specialist network
Initial submission 1-3 days Electronic PA filing 72-hour state requirement
Additional info 1-7 days Respond to requests 5-day response window
Initial decision 3-10 days Review outcome Expedited options available
Internal appeal 30 days File if denied Consumer advocacy support
External review 30 days IRO determination 82% specialty drug success rate

Time-Saving Tips

Portal Optimization: Use electronic submission systems exclusively. Paper submissions can add 5-10 days to processing times.

Bundled Evidence: Submit all required documentation simultaneously rather than piecemeal responses to avoid multiple review cycles.

Specialist Routing: Ensure your endocrinologist is clearly identified as the prescriber. Non-specialist prescribers trigger automatic additional review requirements.

Proactive Renewals: Begin renewal processes 60 days early, especially if you need updated lab work or specialist consultations.

Common Denial Reasons & Fixes

Denial Reason Solution Required Documentation
Insufficient biochemical evidence Submit complete hormone testing Recent UFC (Cushing's) or IGF-1 (acromegaly) results
Non-specialist prescriber Transfer to endocrinologist Specialist consultation notes and prescription
Surgical option not explored Document contraindications Neurosurgical consultation or medical contraindications
Missing step therapy Document prior failures Treatment history with octreotide/lanreotide outcomes
Dosing outside guidelines Justify clinical rationale Literature support and specialist attestation

FAQ

How long does Cigna prior authorization take in Washington? Standard electronic submissions must be processed within 72 hours under Washington law. Expedited requests receive 24-hour turnaround when medical urgency is documented.

What if Signifor is non-formulary on my plan? You can request a formulary exception with clinical justification. Washington's continuity of care laws provide 90-day grace periods if formulary changes occur mid-treatment.

Can I request an expedited appeal? Yes, if treatment delays could seriously affect your health. Document the clinical urgency and request expedited processing at each appeal level.

Does step therapy apply if I've tried treatments outside Washington? Out-of-state treatment records are valid for step therapy documentation. Ensure complete medical records transfer to your Washington endocrinologist.

What happens if I miss an appeal deadline? Washington's 180-day appeal windows are strict. Contact the Insurance Commissioner immediately if you believe you have grounds for an extension due to insurer error.

How much will Signifor cost after approval? As a specialty tier medication, expect significant cost-sharing. Investigate manufacturer copay assistance programs and patient foundation grants to reduce out-of-pocket costs.

Getting the right coverage for rare disease medications like Signifor can feel overwhelming, but you don't have to navigate this process alone. Counterforce Health helps patients, clinicians, and specialty pharmacies turn insurance denials into successful appeals by creating targeted, evidence-backed responses that align with each plan's specific requirements. Their platform analyzes denial letters, identifies the exact approval criteria, and drafts point-by-point rebuttals using the right clinical evidence and procedural requirements.

Whether you're facing an initial denial or preparing for renewal, having the right documentation and understanding Washington's consumer protections puts you in the strongest position for approval. The state's robust appeals framework and high specialty drug overturn rates mean that persistence—backed by proper clinical evidence—often leads to success.

Sources & Further Reading

This guide provides educational information about insurance coverage processes and should not be considered medical advice. Always consult with your healthcare provider about treatment decisions and work with your insurance company directly for coverage determinations. For additional help with appeals in Washington, contact the Office of the Insurance Commissioner at 1-800-562-6900.

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