By Counterforce Health Team in Taltz (ixekizumab) —

How to Get Taltz (ixekizumab) Covered by Cigna in Florida: Prior Authorization Forms, Appeals Timeline, and Approval Strategies

Answer Box: Getting Taltz (ixekizumab) Covered by Cigna in Florida

Taltz (ixekizumab) requires prior authorization from Cigna in Florida and typically mandates step therapy with a TNF inhibitor first. Your prescriber must submit a PA request via electronic portal, CoverMyMeds, or fax to 866-873-8279 with documented TNF inhibitor failure/intolerance and negative tuberculosis screening. If denied, you have 180 days to appeal internally, followed by external review through Florida's Department of Financial Services if needed.

First step today: Ask your doctor to initiate the prior authorization process and ensure TB screening results are current.

Table of Contents

  1. Coverage Basics
  2. Prior Authorization Process
  3. Step Therapy Requirements
  4. Required Lab Tests and Screening
  5. Cost-Saving Programs
  6. Common Denial Reasons and Solutions
  7. Appeals Process in Florida
  8. Specialty Pharmacy Requirements
  9. Renewal and Reauthorization
  10. Troubleshooting Common Issues

Coverage Basics

Is Taltz Covered by Cigna in Florida?

Yes, Taltz (ixekizumab) is typically covered by Cigna plans in Florida, but it's classified as a specialty medication requiring prior authorization. The drug is usually placed on the highest formulary tier (Tier 4 or 5), meaning higher out-of-pocket costs without assistance programs.

Covered indications include:

  • Moderate-to-severe plaque psoriasis (adults and children ≥6 years)
  • Active psoriatic arthritis
  • Ankylosing spondylitis
  • Non-radiographic axial spondyloarthritis

Coverage at a Glance

Requirement What It Means Where to Find It Source
Prior Authorization Doctor must get approval before coverage Cigna PA Forms Cigna Provider Resources
Step Therapy Must try TNF inhibitor first Plan formulary documents Express Scripts PA FAQ
TB Screening Negative test required Lab results in PA submission FDA Prescribing Information
Specialty Pharmacy Must use Accredo or approved network Cigna member portal Cigna Specialty Pharmacy Guide

Prior Authorization Process

Step-by-Step: Fastest Path to Approval

  1. Schedule TB Screening (Patient)
    • Get tuberculin skin test (TST) or blood test (IGRA/QuantiFERON-Gold)
    • Timeline: Results available within 48-72 hours for blood tests
    • Find testing locations
  2. Gather Documentation (Clinic Staff)
    • Previous TNF inhibitor trials and outcomes
    • Current diagnosis codes (ICD-10)
    • Clinical notes supporting medical necessity
    • Timeline: 1-2 business days to compile
  3. Submit Prior Authorization (Prescriber)
    • Electronic submission via Cigna portal (preferred)
    • Alternative: Fax to 866-873-8279
    • Include all required documentation
    • Timeline: Same day submission possible
  4. Track Submission (Patient/Clinic)
    • Follow up within 5-7 days if no response
    • Use Cigna provider portal for status updates
    • Timeline: Decision typically within 72 hours
  5. Appeal if Denied (Patient/Prescriber)
    • Submit within 180 days of denial
    • Include additional supporting evidence
    • Timeline: 60 days for decision, 75 business days for notification

Step Therapy Requirements

Cigna typically requires patients to try and fail (or demonstrate intolerance to) at least one TNF inhibitor before approving Taltz. Common step therapy medications include:

  • TNF Inhibitors: Humira (adalimumab), Enbrel (etanercept), Remicade (infliximab)
  • Documentation needed: Drug name, duration of treatment, reason for discontinuation
  • Exceptions: Medical contraindications, previous intolerance, or urgent clinical need
Clinician Corner: When documenting step therapy failure, include specific details about inadequate response (PASI scores, joint counts), adverse effects, or contraindications. Reference relevant clinical guidelines such as the American Academy of Dermatology psoriasis guidelines for additional support.

Required Lab Tests and Screening

Tuberculosis Screening Requirements

All patients must complete TB screening before starting Taltz:

Accepted Tests:

  • Tuberculin skin test (TST)
  • Interferon gamma release assay (IGRA) - QuantiFERON-Gold or T-SPOT.TB
  • Chest X-ray may be required

Timeline: Screening must be current (typically within 12 months)

Documentation: Include lab results with prior authorization submission

Note: Positive TB screening requires completion of TB treatment before biologic approval. Work with your prescriber to coordinate appropriate anti-TB therapy if needed.

Cost-Saving Programs

Manufacturer Support Programs

Taltz Savings Card

  • Reduces copay to as low as $5 per month
  • Annual cap: $9,200
  • Maximum 14 fills per year, 24 lifetime fills
  • Enrollment required
  • Exclusions: Medicare, Medicaid, other federal programs

SaveOnSP Program

Additional Support

  • Taltz Together™ patient support program: 1-844-TALTZ-NOW
  • Benefits investigation and prior authorization assistance
  • Injection training and adherence support

Common Denial Reasons and Solutions

Denial Reason How to Overturn Required Documentation
No step therapy documentation Submit proof of TNF inhibitor trial Prescription records, clinical notes
Insufficient diagnosis documentation Provide detailed clinical assessment PASI scores, joint counts, imaging
Missing TB screening Submit current test results Lab reports within 12 months
Non-formulary status Request formulary exception Medical necessity letter
Quantity limit exceeded Justify increased dosing Clinical rationale, treatment response

When preparing appeals, Counterforce Health helps patients and clinicians turn insurance denials into targeted, evidence-backed appeals by analyzing denial letters and drafting point-by-point rebuttals aligned to each plan's specific requirements.

Appeals Process in Florida

Internal Appeals Timeline

Submission Deadline: 180 calendar days from denial notice Decision Timeline: 60 days for determination, 75 business days for notification Expedited Appeals: 24-72 hours for urgent cases

Required Documentation

  • Original denial letter
  • Additional clinical evidence
  • Medical necessity letter from prescriber
  • Supporting literature/guidelines

External Review Process

If internal appeals fail, Florida law provides external review through independent organizations:

  1. Eligibility: Must exhaust internal appeals first
  2. Timeline: 4 months after final internal denial
  3. Process: Submit request to Florida Department of Financial Services
  4. Cost: No charge to consumers
  5. Decision: Binding on insurer if overturned
Florida Consumer Assistance: Call the Insurance Consumer Helpline at 1-877-MY-FL-CFO (877-693-5236) for help navigating appeals.

Specialty Pharmacy Requirements

Cigna typically requires Taltz to be filled through their specialty pharmacy network, primarily Accredo:

Why Specialty Pharmacy?

  • Enhanced monitoring and support
  • Coordination with manufacturer programs
  • Temperature-controlled storage and shipping

Accredo Contact: 877-826-7657

Services Included:

  • Benefits verification
  • Prior authorization coordination
  • Injection training
  • Adherence monitoring
  • Side effect management

Renewal and Reauthorization

Typical Authorization Period: 6-12 months Renewal Requirements:

  • Continued medical necessity
  • Treatment response documentation
  • Updated lab work if required
  • No new contraindications

Proactive Renewal Tips:

  • Schedule reauthorization 30 days before expiration
  • Document treatment response with objective measures
  • Update any changes in medical history

Troubleshooting Common Issues

Portal Access Problems

  • Contact Cigna provider services: 800-882-4462
  • Verify current login credentials
  • Clear browser cache and try again

Missing Forms or Documentation

  • Download current forms from Cigna's resource library
  • Contact prescriber's office for clinical notes
  • Request prescription history from previous pharmacies

Delayed Responses

  • Follow up every 5-7 business days
  • Request peer-to-peer review if available
  • Consider expedited review for urgent cases

Frequently Asked Questions

Q: How long does Cigna prior authorization take for Taltz in Florida? A: Standard PA decisions are typically made within 72 hours of complete submission. Expedited reviews can be completed within 24 hours for urgent cases.

Q: What if Taltz is not on my Cigna formulary? A: Your prescriber can submit a formulary exception request with clinical justification. The review process follows similar timelines to standard PA requests.

Q: Can I appeal if I haven't tried a TNF inhibitor? A: Yes, if you have medical contraindications or previous intolerance to TNF inhibitors, your prescriber can document these in the initial PA or appeal.

Q: Does step therapy apply if I tried TNF inhibitors in another state? A: Yes, prior therapy documentation from any location is typically accepted as long as it's properly documented in your medical records.

Q: What happens if my appeal is denied? A: You can request external review through Florida's Department of Financial Services, which provides independent medical review at no cost to you.

For patients and clinicians facing complex insurance denials, Counterforce Health specializes in transforming denial letters into comprehensive, evidence-backed appeals that align with each payer's specific policies and requirements. Their platform helps identify the exact denial basis and drafts targeted rebuttals using appropriate medical literature and clinical guidelines.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always consult with your healthcare provider and insurance company for the most current coverage policies and medical guidance specific to your situation. Coverage policies and requirements may change, so verify current information with official sources.

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