By Counterforce Health Team in Taltz (ixekizumab) —

How to Get Taltz (Ixekizumab) Covered by Cigna in Virginia: Complete Guide to Forms, Appeals, and Step Therapy

Answer Box: Getting Taltz (Ixekizumab) Covered by Cigna in Virginia

Fastest Path to Approval: Have your dermatologist or rheumatologist submit Cigna's Taltz Prior Authorization Form electronically via CoverMyMeds or fax to 1-866-873-8279. Include documentation of your psoriasis/psoriatic arthritis diagnosis, failed trials with conventional therapies (like methotrexate for 3+ months), and objective disease activity scores (PASI, DAPSA, or BSA affected).

If denied, request a formulary exception using Virginia's Pharmacy Formulary Exception Form, then pursue Virginia's external review through the State Corporation Commission if needed.

Start today: Call your doctor's office to request your medical records showing previous treatment failures and current disease severity scores.

Table of Contents

  1. Verify Your Cigna Plan Coverage
  2. Required Forms and Documentation
  3. Electronic Submission Portals
  4. Fax and Mail Submission
  5. Specialty Pharmacy Setup (Accredo)
  6. Support Lines and Contacts
  7. Virginia Appeals and External Review
  8. Common Denial Reasons and Solutions
  9. When to Update Your Resources

Verify Your Cigna Plan Coverage

Before starting the prior authorization process, confirm your specific Cigna plan's requirements for Taltz (ixekizumab). Most Cigna plans classify Taltz as a specialty medication requiring prior authorization and often step therapy.

Check your plan details:

  • Log into your myCigna account to view your prescription benefits
  • Look for "specialty tier" copays (typically $50-$150+ per month)
  • Verify if Express Scripts or Accredo manages your specialty medications
Note: Cigna's formulary varies by state and plan type. Virginia members should specifically request Virginia-specific forms when available.

Required Forms and Documentation

Primary Prior Authorization Form

Your prescriber must complete the Cigna Taltz Prior Authorization Form, last updated September 2025. The form requires:

  • Patient Information: Full name, Cigna ID, date of birth, contact details
  • Prescriber Details: Specialist credentials (dermatologist/rheumatologist preferred)
  • Clinical Information:
    • ICD-10 diagnosis code for psoriasis (L40.x) or psoriatic arthritis (L40.5x)
    • Requested dose and frequency
    • Duration of treatment

Required Clinical Documentation

According to Cigna's coverage policy, you must provide:

For Psoriasis:

  • Failed trial of at least one conventional systemic therapy (methotrexate, cyclosporine, acitretin) for ≥3 months
  • Baseline disease activity: % body surface area (BSA), PASI score, or Physician Global Assessment (PGA)

For Psoriatic Arthritis:

  • Documentation of active disease with objective measures:
    • Disease Activity Index for Psoriatic Arthritis (DAPSA)
    • Composite Psoriatic Disease Activity Index (CPDAI)
    • Relevant lab values (CRP, ESR)

Step Therapy Exception Form

If Taltz isn't on your formulary or requires step therapy, request an exception using Virginia's Pharmacy Formulary Exception Form. This form allows your doctor to certify that:

  • Required step therapy drugs were ineffective or caused adverse reactions
  • Taltz is medically necessary based on your specific clinical situation

Electronic Submission Portals

Preferred Method: Electronic prior authorization (ePA) through:

  • CoverMyMeds: Most efficient option for Cigna submissions
  • SureScripts: Alternative electronic platform

Advantages of Electronic Submission:

  • Faster processing (typically 3-5 business days vs. 7-10 for fax)
  • Automatic confirmation of receipt
  • Real-time status updates
  • Reduced paperwork errors

Your prescriber's office should have access to these platforms. If they're unfamiliar with ePA for Cigna, they can call Cigna Provider Services at 1-800-88-CIGNA for setup assistance.

Fax and Mail Submission

If electronic submission isn't available:

Fax: 1-866-873-8279
Standard Mail: Check current address on your plan documents (verify with Cigna as addresses may change)

Cover Sheet Tips:

  • Include "URGENT - PRIOR AUTHORIZATION REQUEST" if time-sensitive
  • List all attached documents
  • Provide clear contact information for follow-up questions
  • Include patient's Cigna ID prominently

Specialty Pharmacy Setup (Accredo)

Once approved, Cigna typically requires Taltz to be dispensed through Accredo, their specialty pharmacy partner.

Enrollment Process:

  1. Automatic Transfer: If you have an existing prescription elsewhere, Accredo will contact you about transferring
  2. New Prescriptions: Your doctor sends the prescription directly to Accredo
  3. Patient Enrollment: Accredo calls within 1-2 business days to:
    • Verify insurance and contact information
    • Schedule delivery (free shipping)
    • Discuss injection training if needed
    • Apply manufacturer copay assistance

Accredo Contact Information:

  • Patient Services: 800-803-2523
  • Physician Service Center: 844-516-3319
  • Fax for Prescriptions: 888-302-1028

Managing Your Account:

  • Use the myCigna portal for refills and tracking
  • Download the MyAccredo app for mobile management
  • Set up automatic refills to avoid interruptions

Support Lines and Contacts

For Patients:

  • Cigna Customer Service: 1-800-Cigna24 (1-800-244-6224)
  • Prior Authorization Status: Available through myCigna portal or customer service
  • Accredo Patient Support: 800-803-2523

For Providers:

  • Cigna Provider Services: 1-800-88-CIGNA
  • Prior Authorization Help: Available through Cigna's provider portal
  • Peer-to-Peer Review Requests: Can be scheduled through provider services

What to Ask When Calling:

  • Current status of your prior authorization request
  • Specific reasons for any delays or additional information needed
  • Timeline for decision
  • Next steps if denied

Virginia Appeals and External Review

If Cigna denies your Taltz prior authorization, Virginia provides strong patient protection rights.

Internal Appeals with Cigna

  • Timeline: File within 180 days of denial
  • Process: Submit additional clinical documentation and medical necessity letter
  • Decision: Cigna has 72 hours for urgent appeals, 15 days for standard appeals

Virginia External Review

If Cigna's internal appeals are unsuccessful, Virginia's State Corporation Commission Bureau of Insurance offers independent review:

Eligibility: Denials based on medical necessity or experimental/investigational determinations
Timeline: File Form 216-A within 120 days of final denial
Cost: Free to Virginia residents
Decision Timeline: 45 days for standard review, 72 hours for expedited

Contact Information:

Virginia Advantage: Virginia allows expedited external review for certain conditions without exhausting all internal appeals, particularly for cancer treatments and other urgent medical needs.

Common Denial Reasons and Solutions

Denial Reason Solution Required Documentation
Insufficient documentation of diagnosis Submit complete medical records with ICD-10 codes Chart notes, lab results, imaging
No evidence of step therapy failure Document previous treatment trials and outcomes Prescription history, progress notes showing failure/intolerance
Missing disease activity scores Provide baseline and current objective measures PASI, DAPSA, BSA measurements, photos if applicable
Non-formulary medication File formulary exception request Virginia Exception Form
Quantity limits exceeded Justify medical necessity for requested dosing Clinical rationale for dose/frequency, FDA labeling support

Clinician Corner: Medical Necessity Letter Checklist

Healthcare providers should include these elements in medical necessity letters:

✓ Patient's specific diagnosis with ICD-10 codes
✓ Complete treatment history including dates, doses, and outcomes of previous therapies
✓ Objective disease activity measures (PASI, DAPSA, BSA, etc.)
✓ Clinical rationale for Taltz specifically
✓ Contraindications or failures with alternative treatments
✓ Treatment goals and expected outcomes
✓ Monitoring plan and safety considerations

Key Guidelines to Reference:

  • FDA-approved labeling for Taltz
  • American Academy of Dermatology psoriasis treatment guidelines
  • American College of Rheumatology psoriatic arthritis recommendations

When to Update Your Resources

Healthcare coverage policies and forms change regularly. Check for updates:

Quarterly: Review Cigna's formulary changes and prior authorization requirements
Annually: Verify Virginia's external review procedures and contact information
Before Each Submission: Confirm you're using the most current forms

Counterforce Health helps patients and clinicians navigate these complex approval processes by automatically identifying the latest requirements and crafting targeted appeals that address payer-specific criteria. Our platform streamlines the documentation process and tracks policy changes across different insurers and states. Learn more about our coverage advocacy services.

Frequently Asked Questions

Q: How long does Cigna prior authorization take for Taltz in Virginia?
A: Electronic submissions typically receive decisions within 3-5 business days. Fax submissions may take 7-10 business days. Urgent requests can be expedited to 24-72 hours.

Q: What if my doctor isn't a specialist?
A: While Cigna prefers dermatologists or rheumatologists to prescribe Taltz, primary care physicians can submit prior authorizations with strong clinical documentation and specialist consultation notes.

Q: Can I appeal if I've been stable on Taltz but Cigna wants me to switch?
A: Yes. Document your current disease control, any previous failures with alternative medications, and potential risks of switching. This often succeeds in continuation appeals.

Q: Does Virginia have any special protections for psoriasis patients?
A: Virginia's external review process is particularly patient-friendly, with no cost to the patient and expedited timelines for urgent medical needs.

Q: What if my employer's plan is self-funded?
A: Some self-funded plans opt into Virginia's external review process. If not, you may have federal external review rights through HHS. The Bureau of Insurance can help direct you to the appropriate process.

Cost and Financial Assistance

Manufacturer Support: Eli Lilly offers the Taltz Savings Program for eligible patients with commercial insurance.

Copay Assistance: May reduce out-of-pocket costs to as low as $5 per month for qualifying patients.

Foundation Support: Organizations like the Patient Access Network Foundation and CancerCare may provide grants for eligible patients.

At Counterforce Health, we understand that navigating insurance approvals for specialty medications like Taltz can be overwhelming. Our platform helps transform denials into successful appeals by identifying the specific clinical evidence and documentation that payers require, making the process more efficient for both patients and their healthcare providers.

Sources and Further Reading

Disclaimer: This guide provides general information about insurance coverage processes and should not be considered medical or legal advice. Coverage policies vary by plan and change over time. Always consult with your healthcare provider about treatment decisions and verify current requirements with your insurance plan. For personalized assistance with appeals or coverage issues, consider consulting with a patient advocate or the Virginia State Corporation Commission Bureau of Insurance.

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