By Counterforce Health Team in Voxzogo (vosoritide) —

How to Get Voxzogo (vosoritide) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Fastest Path to Voxzogo Coverage

To get Voxzogo (vosoritide) covered by Cigna in Washington, you need: confirmed achondroplasia diagnosis with FGFR3 genetic testing, open growth plates documented by imaging, and prescription from a pediatric endocrinologist or geneticist. Submit Cigna's prior authorization form with all supporting documentation. If denied, file internal appeals within 180 days, then request external review through Washington's Independent Review Organization (IRO). Start today: Contact your child's specialist to gather genetic test results and schedule growth plate imaging.

Table of Contents

  1. What This Guide Covers
  2. Before You Start: Verify Your Coverage
  3. Gather Required Documentation
  4. Submit the Prior Authorization Request
  5. Follow-Up and Tracking
  6. Typical Timelines in Washington
  7. If You're Asked for More Information
  8. If Denied: Appeals Process
  9. Renewal and Reauthorization
  10. FAQ
  11. Quick Reference Checklist

What This Guide Covers

This guide helps families in Washington get Voxzogo (vosoritide) approved by Cigna for children with achondroplasia. Voxzogo is the first FDA-approved medication to increase growth velocity in pediatric patients with this genetic form of dwarfism.

Who this helps:

  • Parents of children with achondroplasia (ages 2-17 with open growth plates)
  • Pediatric endocrinologists and geneticists submitting prior authorizations
  • Families facing Cigna denials who need appeal guidance

Expected outcomes: With complete documentation, most eligible patients receive approval. If initially denied, appeals succeed when proper evidence is provided—especially genetic confirmation and specialist support.

Before You Start: Verify Your Coverage

Check Your Plan Type

Voxzogo is covered as a specialty medication under Cigna's medical benefit, not standard pharmacy coverage. Contact Cigna member services at the number on your insurance card to confirm:

  • Your plan covers specialty medications
  • Whether you have a separate specialty pharmacy deductible
  • Your estimated out-of-pocket costs

Verify Network Status

Ensure your child's pediatric endocrinologist or geneticist is in-network with Cigna. Out-of-network specialists may require additional authorization steps.

Formulary Status

Voxzogo requires prior authorization regardless of formulary tier. It's not available through standard retail pharmacies—distribution occurs through specialty pharmacy channels.

Gather Required Documentation

Essential documents for Cigna prior authorization:

Medical Documentation

  • Genetic test report confirming FGFR3 pathogenic variant causing achondroplasia
  • Growth plate imaging (X-rays) documenting open epiphyses within past 3-6 months
  • Specialist consultation notes from pediatric endocrinologist or medical geneticist
  • Growth charts showing baseline growth velocity
  • Medical history documenting any prior growth hormone therapy (must be discontinued)

Administrative Requirements

  • Completed Cigna prior authorization form (verify current version)
  • Patient demographics and insurance information
  • Prescriber DEA number and NPI
  • Statement confirming no planned limb-lengthening surgery during treatment
Tip: BioMarin's RareConnections program provides PA templates and documentation checklists. Contact them early in the process for support.

Submit the Prior Authorization Request

Submission Methods

For Cigna providers:

  • Electronic submission through Cigna's provider portal (preferred)
  • Fax: Submit to specialty pharmacy prior authorization fax line (confirm current number with Cigna)
  • Phone: Call Cigna provider services for urgent requests

Clean Request Packet Checklist

✅ Completed PA form with all fields filled
✅ Genetic test report attached
✅ Growth plate imaging report
✅ Specialist consultation notes
✅ Growth velocity documentation
✅ Statement about limb-lengthening surgery status
✅ Prescriber attestation signed and dated

Specialty Pharmacy Routing

Voxzogo is distributed through Cigna's specialty pharmacy network. Your provider will coordinate with the designated specialty pharmacy for fulfillment once approved.

Follow-Up and Tracking

When to Call Cigna

  • Day 3: Confirm receipt of PA request
  • Day 10: Check status if no response received
  • Day 14: Escalate if approaching decision deadline

Sample Call Script

"I'm calling to check the status of a prior authorization request for Voxzogo for [patient name], DOB [date], member ID [number]. The request was submitted on [date] by Dr. [name]. Can you provide the current status and expected decision date?"

Documentation

Keep records of:

  • Reference numbers for all calls
  • Names of representatives spoken with
  • Dates and outcomes of conversations
  • Any additional information requested

Typical Timelines in Washington

Request Type Cigna Decision Timeline Notes
Standard PA 15 business days Most common pathway
Urgent/Expedited 72 hours For children with severe complications
Additional Information 5 business days after receipt Clock stops until received

Washington State Requirements: Insurers must respond to prior authorization requests within timeframes that don't delay medically necessary care. If Cigna doesn't respond within required timeframes, you can file a complaint with the Washington Insurance Commissioner.

If You're Asked for More Information

Common Requests

Genetic confirmation: Cigna may request specific documentation that the FGFR3 variant is pathogenic and causes achondroplasia (not just a variant of uncertain significance).

Growth plate status: Clear radiologist interpretation stating "open epiphyses" or "unfused growth plates."

Specialist qualifications: Documentation that the prescriber is a pediatric endocrinologist or medical geneticist.

Medical Necessity Letters

Your specialist should address:

  • Why Voxzogo is medically necessary for your child
  • How achondroplasia impacts growth and development
  • Expected benefits of treatment
  • Lack of FDA-approved alternatives

If Denied: Appeals Process

Understanding Cigna's Decision

Common denial reasons:

  • Missing genetic confirmation
  • Unclear growth plate status
  • Prescriber not recognized specialist
  • Patient outside age range or with closed growth plates
  • Incomplete prior authorization form

Internal Appeals with Cigna

First-level appeal:

  • File within 180 days of denial
  • Submit additional documentation addressing denial reasons
  • Request peer-to-peer review with pediatric specialist

Second-level appeal:

  • Available if first appeal is denied
  • Reviewed by different medical director
  • Include updated clinical information if available

External Review in Washington

If Cigna upholds the denial after internal appeals, you can request external review through Washington's Independent Review Organization (IRO) process.

Key details:

  • Request within 180 days of final internal denial
  • No cost to you for the review
  • Decision is binding on Cigna
  • Timeline: 15-20 days for standard review, 72 hours for expedited

To initiate external review:

  1. Contact Cigna to request external review
  2. Cigna forwards your case to Washington's Insurance Commissioner
  3. An independent medical expert reviews your case
  4. Decision is issued and binding

Contact for help: Washington Insurance Commissioner Consumer Advocacy: 1-800-562-6900

From our advocates: We've seen families successfully overturn Voxzogo denials by working closely with their geneticist to provide detailed documentation of the FGFR3 variant's pathogenicity and clear evidence of open growth plates. The key is thorough specialist support and persistence through the appeals process.

Renewal and Reauthorization

When to Start

Begin renewal process 60 days before current authorization expires. Cigna typically approves Voxzogo for 12-month periods.

Required Documentation for Renewal

  • Growth response data showing increased growth velocity
  • Updated growth plate imaging confirming continued open epiphyses
  • Specialist assessment of treatment benefit and ongoing medical necessity
  • Safety monitoring results (if applicable)

Calendar Reminders

Set reminders for:

  • 90 days before expiration: Schedule specialist appointment
  • 60 days before: Submit renewal request
  • 30 days before: Follow up on status

FAQ

How long does Cigna prior authorization take for Voxzogo in Washington? Standard requests: 15 business days. Expedited requests for urgent medical situations: 72 hours.

What if Voxzogo is non-formulary on my Cigna plan? Request a formulary exception with your prior authorization. Emphasize that no FDA-approved alternatives exist for achondroplasia.

Can I request an expedited appeal in Washington? Yes, if delay would seriously jeopardize your child's health. Contact Cigna to request expedited internal review, and if denied, expedited external review through the IRO process.

Does step therapy apply to Voxzogo? Generally no, since there are no FDA-approved alternatives for achondroplasia. However, Cigna may require documentation that growth hormone therapy was discontinued.

What if my child's geneticist is out-of-network? Request a network exception from Cigna, emphasizing the specialized nature of achondroplasia care and limited in-network specialist availability.

How much will Voxzogo cost with Cigna coverage? Costs vary by plan. Contact Cigna to understand your specialty medication benefits, deductibles, and out-of-pocket maximums. BioMarin offers copay assistance programs for eligible patients.

Quick Reference Checklist

Before submitting: □ Genetic test confirming FGFR3 achondroplasia
□ Growth plate X-rays showing open epiphyses
□ Specialist (pediatric endo/geneticist) prescription
□ Completed Cigna PA form
□ Growth charts and baseline data
□ Statement about limb-lengthening surgery

After submission: □ Track reference number
□ Follow up at day 3, 10, and 14
□ Respond quickly to information requests
□ File appeals within 180 days if denied
□ Contact Washington Insurance Commissioner if needed

For renewals: □ Start process 60 days early
□ Document growth response
□ Update growth plate imaging
□ Get specialist reassessment

About Coverage Navigation: Counterforce Health helps patients, clinicians, and specialty pharmacies turn insurance denials into successful appeals by providing evidence-backed, payer-specific rebuttal letters. Their platform analyzes denial reasons and drafts targeted responses aligned with each plan's specific requirements, helping families access critical medications like Voxzogo more efficiently.

For additional support with Voxzogo appeals or complex prior authorization challenges, Counterforce Health's specialized approach to insurance denials can help strengthen your case with the precise documentation and medical evidence that Cigna requires.

Sources & Further Reading

Medical Disclaimer: This guide provides general information about insurance coverage and appeals processes. It is not medical advice and does not replace consultation with qualified healthcare providers. Always consult your child's medical team for treatment decisions and work with them on prior authorization and appeals processes. Coverage policies and procedures may change; verify current requirements with your insurer and healthcare providers.

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