By Counterforce Health Team in Voxzogo (vosoritide) —

How to Get Voxzogo (Vosoritide) Covered by Cigna in Michigan: Forms, Appeals, and Approval Guide

Quick Answer: Cigna covers Voxzogo (vosoritide) for pediatric achondroplasia patients with confirmed FGFR3 mutations and open growth plates when prescribed by a pediatric endocrinologist or geneticist. Submit prior authorization via CoverMyMeds or EviCore portal with genetic testing, growth plate imaging, and specialist documentation. If denied, appeal within 180 days, then file Michigan DIFS external review within 127 days using Form FIS 0018. Start with BioMarin RareConnections at 1-866-906-6100 for PA support.

Table of Contents

Verify Your Coverage

Before starting the prior authorization process, confirm your specific Cigna plan covers specialty medications through Express Scripts. Log into your myCigna portal or call the number on your insurance card to verify:

  • Whether Voxzogo requires prior authorization (it does for most plans)
  • Your specialty pharmacy network (typically Accredo for Express Scripts)
  • Any step therapy requirements (none exist for achondroplasia)
  • Your plan's formulary tier for Voxzogo
Note: Cigna typically manages specialty drugs like Voxzogo through Express Scripts/Accredo, requiring network specialty pharmacy use.

Required Forms and Documentation

Prior Authorization Requirements

Cigna's medical policy requires ALL of the following documentation:

Requirement Specific Evidence Where to Obtain
FGFR3 Genetic Confirmation Lab report showing pathogenic FGFR3 variant (c.1138G>A or c.1138G>C) Genetic testing lab
Open Growth Plates Recent X-ray or MRI of bilateral lower extremities Radiology department
Age Eligibility Patient <18 years with achondroplasia Medical records
Specialist Oversight Prescription from pediatric endocrinologist or medical geneticist Specialist clinic
Baseline Growth Data Achondroplasia-specific growth charts, height/weight measurements Clinic records
No Concurrent Surgery Documentation that no limb-lengthening surgery is planned Orthopedic records

Key Forms to Complete

Primary Submission: Use electronic prior authorization via CoverMyMeds (fastest) or EviCore by Evernorth portal for Cigna/Express Scripts pharmacy drugs.

Alternative Submission: If electronic PA isn't available, fax Cigna's General Drug Prior Authorization Form to 1-855-840-1678.

Submission Portals and Methods

  • CoverMyMeds: 80% faster processing than fax submissions
  • EviCore Portal: Select "Pharmacy Drugs (Express Scripts Coverage)"
  • Phone: 1-800-882-4462 for verbal PA if electronic options unavailable

Fax Submissions

  • Express Scripts General Request: 1-877-251-5896
  • Cigna PA Form: 1-855-840-1678 (mark "Urgent" if standard 2-day review risks patient health)

Review Timelines

Review Type Processing Time Eligibility
Standard 2 business days Complete documentation required
Expedited 24 hours Life/health-threatening cases with physician attestation
Step Therapy Exception 2 business days Prior drug ineffective/harmful

Fastest Path to Approval

Step-by-Step Process

  1. Gather Documentation (Patient/Clinic): Collect FGFR3 genetic test, growth plate imaging, specialist notes, and growth charts before submission.
  2. Submit Electronic PA (Prescriber): Use CoverMyMeds or EviCore portal immediately with all required documentation. Include ICD-10 code Q77.01 (achondroplasia).
  3. Track Submission (Clinic Staff): Monitor status through portal or call Cigna member services within 3 business days.
  4. Pharmacy Enrollment (Patient): Contact BioMarin RareConnections at 1-866-906-6100 for Accredo specialty pharmacy enrollment while PA processes.
  5. Follow-Up (Prescriber): If no response in 2 business days, call Cigna provider services to check status.
  6. Appeal if Denied (Patient/Clinic): Submit internal appeal within 180 days with additional clinical documentation.
  7. External Review (Patient): If internal appeal fails, file Michigan DIFS external review within 127 days.

Common Denial Reasons & Solutions

Denial Reason Required Fix Supporting Documentation
"Missing genetic confirmation" Submit FGFR3 test results Lab report with pathogenic variant identification
"Growth plates closed" Provide recent imaging X-ray/MRI dated within 6 months showing open epiphyses
"Not prescribed by specialist" Get referral or consultation Pediatric endocrinologist or geneticist prescription
"Insufficient growth data" Submit baseline measurements Achondroplasia-specific growth charts with plotted data
"Concurrent surgery planned" Document no surgery Orthopedic note confirming no limb-lengthening procedures

Appeals Process in Michigan

Internal Appeal (First Level)

  • Deadline: 180 calendar days from denial notice
  • Submission: Written request via Cigna's Medical Appeal Request Form
  • Timeline: 30 calendar days for decision
  • Requirements: Include denial letter, medical records, and physician letter explaining medical necessity

Michigan External Review (Second Level)

After exhausting Cigna's internal appeal, file with Michigan Department of Insurance and Financial Services (DIFS):

  • Deadline: 127 days from final internal denial
  • Form: Michigan DIFS Form FIS 0018
  • Submission: Online at difs.state.mi.us (preferred) or fax to 517-284-8838
  • Timeline: 60 days for standard review; 72 hours for expedited cases
  • Contact: 877-999-6442 for questions
Tip: Michigan's external review has a 50%+ overturn rate when proper medical evidence is provided, especially for rare disease treatments with clear clinical guidelines.

Specialty Pharmacy Enrollment

Accredo Enrollment Process

Voxzogo requires enrollment with Accredo, Cigna's preferred specialty pharmacy partner:

  1. Prescriber Completes: Accredo Prescription & Enrollment Form
  2. Required Information: Patient demographics, clinical details (ICD-10 Q77.01, weight in kg, height in cm), prescribing details
  3. Fax Submission: 888-302-1028 (use MAP Fax Rx for tracking)
  4. BioMarin Quick Enroll: Call 1-866-906-6100 for streamlined enrollment assistance

Shipping Options

  • Patient's home address (most common)
  • Prescriber's office
  • Infusion site (if applicable)

Support Resources

Financial Assistance

  • BioMarin RareConnections: Up to $18,200/year copay assistance for commercial plans
  • Contact: 1-833-869-9646 (Mon-Fri, 8AM-8PM PT)
  • Services: PA support, injection training, reimbursement education

Coverage Authorization Tools

Michigan Consumer Assistance

  • Michigan DIFS Consumer Hotline: 877-999-6442
  • Services: Appeals guidance, external review assistance, insurance complaint filing

When patients face complex insurance denials, specialized platforms like Counterforce Health help turn denials into targeted, evidence-backed appeals by analyzing denial letters, plan policies, and clinical notes to draft point-by-point rebuttals aligned with payer requirements.

FAQ

How long does Cigna PA take for Voxzogo in Michigan? Standard prior authorization takes 2 business days with complete documentation. Expedited review (24 hours) available for urgent medical situations with physician attestation.

What if Voxzogo is non-formulary on my plan? Request a formulary exception through your physician using Cigna's exception process. Include medical necessity documentation explaining why formulary alternatives are inappropriate for achondroplasia.

Can I request an expedited appeal in Michigan? Yes, both Cigna internal appeals and Michigan DIFS external reviews offer expedited processes for urgent medical situations requiring physician documentation of health risks from delays.

Does step therapy apply to Voxzogo? No step therapy requirements exist for achondroplasia treatment since Voxzogo is the only FDA-approved pharmacologic therapy for this condition.

What happens if my appeal is denied? After exhausting Cigna's internal appeals, file a Michigan DIFS external review within 127 days. The independent medical review is binding and has favorable overturn rates for well-documented rare disease cases.

How much does Voxzogo cost without insurance? List price is approximately $320,000 annually before rebates. BioMarin RareConnections offers copay assistance up to $18,200/year for commercial insurance, often reducing patient costs to $0-$50/month.

From our advocates: We've seen families successfully obtain Voxzogo coverage after initial denials by ensuring genetic testing clearly documents the FGFR3 mutation type and submitting recent growth plate imaging with specialist interpretation. The key is providing complete documentation upfront rather than piecemeal submissions that delay approval.

For complex denials requiring detailed clinical rebuttals, Counterforce Health specializes in analyzing payer policies and crafting evidence-based appeals that address specific denial reasons with appropriate medical literature and clinical documentation.

Sources & Further Reading

This guide is for informational purposes only and does not constitute medical or legal advice. Coverage decisions depend on individual plan terms and medical circumstances. Consult your healthcare provider and insurance plan for specific guidance. For assistance with insurance appeals in Michigan, contact DIFS at 877-999-6442 or visit michigan.gov/difs.

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