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

Myths vs. Facts: Getting Signifor / Signifor LAR (pasireotide) Covered by Cigna in Texas

Answer Box: Getting Signifor / Signifor LAR (pasireotide) Covered by Cigna in Texas

Cigna requires prior authorization for Signifor/Signifor LAR through Express Scripts/Accredo specialty pharmacy. For acromegaly, you must first try and fail octreotide LAR and lanreotide depot. For Cushing's disease, step therapy is less restrictive. Key requirements: endocrinologist prescriber, biochemical confirmation (elevated IGF-1 for acromegaly, elevated 24-hour UFC for Cushing's), and documented surgical failure or ineligibility. First step: Have your endocrinologist gather labs, prior therapy records, and surgical documentation before submitting PA via Cigna provider portal.

Table of Contents

Why Myths About Signifor Coverage Persist

Signifor and Signifor LAR (pasireotide) represent breakthrough treatments for rare endocrine conditions like Cushing's disease and acromegaly. But with costs often exceeding $20,000 per vial, misinformation about insurance coverage spreads quickly among patients and even some healthcare providers.

These myths persist because Cigna's coverage policies are complex, buried in lengthy PDFs, and change regularly. Many patients receive conflicting advice from different sources, while clinics may not stay current on the latest prior authorization requirements. The result? Unnecessary delays, denials, and frustration for patients who need these life-changing medications.

Counterforce Health helps patients navigate these exact challenges by turning insurance denials into targeted, evidence-backed appeals. The platform analyzes denial letters and payer policies to identify the specific reasons for rejection, then drafts point-by-point rebuttals using the right clinical evidence and citations.

Common Myths vs. Facts

Myth 1: "If my endocrinologist prescribes Signifor, Cigna has to cover it"

Fact: Cigna requires prior authorization for all Signifor formulations, regardless of prescriber specialty. Your endocrinologist must submit detailed clinical documentation proving medical necessity according to Cigna's specific criteria.

Myth 2: "I can get Signifor LAR for acromegaly without trying other medications first"

Fact: Cigna mandates step therapy for acromegaly, requiring documented trial and failure of both octreotide LAR (Sandostatin LAR) and lanreotide depot (Somatuline Depot) at maximum tolerated doses before approving Signifor LAR.

Myth 3: "Any doctor can prescribe Signifor for insurance approval"

Fact: Cigna policies explicitly require prescription by an endocrinologist with documented NPI. Primary care physicians or other specialists typically won't meet the prescriber requirements for approval.

Myth 4: "If Cigna denies my initial request, I can't get it covered"

Fact: Texas law provides robust appeal rights. You have 180 days to file an internal appeal, and if that's denied, you can request an independent external review through the Texas Department of Insurance within 4 months. External reviews overturn many initial denials when proper documentation is provided.

Myth 5: "I need to pay out-of-pocket while waiting for approval"

Fact: You can request expedited review if delays would jeopardize your health. Cigna must respond to expedited requests within 72 hours for prior authorization and 24 hours for urgent appeals.

Myth 6: "Signifor isn't on Cigna's formulary, so it won't be covered"

Fact: Even non-formulary medications can be covered through formulary exceptions when medically necessary. Your endocrinologist can request an exception with proper clinical justification.

Myth 7: "I can use any specialty pharmacy for Signifor"

Fact: Cigna routes Signifor through Express Scripts/Accredo specialty pharmacy specifically. Using other pharmacies will result in coverage denial, even with prior authorization approval.

Myth 8: "Lab results from any timeframe are acceptable for approval"

Fact: Cigna requires recent biochemical confirmation—typically within 3-6 months for IGF-1 levels in acromegaly and 24-hour urinary free cortisol (UFC) collections for Cushing's disease. Older lab results may trigger denial.

What Actually Influences Approval

Understanding Cigna's real approval criteria helps you avoid denials and appeals altogether:

Medical Necessity Documentation

Condition Required Lab Evidence Additional Requirements
Acromegaly Elevated IGF-1 above age/gender norms; GH >5 ng/mL on ≥2 occasions Confirmed surgical failure/ineligibility; documented failure of octreotide LAR and lanreotide depot
Cushing's Disease Elevated 24-hour UFC from ≥2 collections; ACTH-dependent hypercortisolism Pituitary source confirmation via MRI; surgical failure or ineligibility

Prescriber Requirements

  • Board-certified endocrinologist with valid NPI
  • Detailed letter of medical necessity referencing FDA labeling and clinical guidelines
  • Treatment plan including monitoring parameters

Administrative Factors

  • Submission through correct channels (Cigna provider portal or designated fax)
  • Complete prior therapy documentation with specific doses, durations, and failure reasons
  • ICD-10 codes matching approved indications
From our advocates: We've seen cases where patients were initially denied because their endocrinologist submitted incomplete prior therapy records. After gathering detailed pharmacy records showing specific octreotide and lanreotide doses tried over 6+ months, the same patient was approved within 48 hours on resubmission. The key was documenting not just that other medications were tried, but exactly how they failed to control IGF-1 levels.

Avoid These Critical Mistakes

1. Incomplete Step Therapy Documentation

For acromegaly patients, simply stating "tried octreotide" isn't sufficient. Cigna requires:

  • Specific drug names and doses (e.g., "octreotide LAR 30 mg monthly for 6 months")
  • Duration of each trial
  • Objective failure criteria (lab values showing inadequate IGF-1 control)
  • Reason for discontinuation (lack of efficacy vs. intolerance)

2. Using Non-Specialist Prescribers

Even if your primary care doctor is comfortable managing your condition, Cigna's policies specifically require endocrinologist prescription. This isn't negotiable and will result in automatic denial.

3. Missing Biochemical Confirmation

Vague statements like "patient has acromegaly" don't meet medical necessity requirements. Include:

  • Specific lab values with reference ranges
  • Dates of testing
  • Relationship to normal limits (e.g., "IGF-1 485 ng/mL, normal range 101-267 ng/mL for age 45 male")

4. Wrong Pharmacy Network

Even with prior authorization approval, using a non-Accredo pharmacy will result in claim denial. Ensure your prescription is sent directly to Accredo after PA approval.

5. Inadequate Appeal Documentation

If initially denied, don't just resubmit the same information. Counterforce Health specializes in analyzing denial letters to identify exactly what additional evidence is needed for successful appeals.

Your 3-Step Action Plan

Step 1: Verify Your Coverage (Today)

  • Call Cigna member services at 1-800-88CIGNA with your member ID
  • Confirm your plan includes specialty drug coverage through Express Scripts/Accredo
  • Ask for your specific formulary tier for pasireotide (Signifor/Signifor LAR)
  • Verify if your plan is self-funded ERISA (affects appeal rights)

Step 2: Gather Required Documentation (This Week)

Work with your endocrinologist to compile:

  • Recent lab results (IGF-1 for acromegaly, 24-hour UFC for Cushing's)
  • Complete prior therapy records with doses and durations
  • Surgical reports or documentation of ineligibility
  • Current treatment plan and monitoring schedule

Step 3: Submit Prior Authorization (Next Week)

  • Endocrinologist submits PA through Cigna provider portal
  • Include all required documentation in initial submission
  • Request expedited review if clinically urgent (72-hour response)
  • Track submission status through provider portal

Texas-Specific Appeal Process

If Cigna denies your initial prior authorization, Texas law provides strong patient protections:

Internal Appeals (Required First Step)

  • Deadline: 180 days from denial notice
  • Timeline: 30 days for standard review, 72 hours for expedited
  • How to submit: Cigna member portal, mail, or fax to 1-866-873-8279
  • Required documents: Original denial letter, medical records, physician support letter

External Review (Independent Review Organization)

  • Eligibility: After exhausting internal appeals for medical necessity denials
  • Deadline: 4 months from final internal denial
  • Process: Submit TDI Form LHL009 to Texas Department of Insurance
  • Timeline: 20 days standard, 5 days expedited for urgent cases
  • Outcome: Binding decision on Cigna; free to patients

Peer-to-Peer Review Option

Before formal appeals, request a peer-to-peer discussion between your endocrinologist and Cigna's medical director. This often resolves denials faster than the formal process.

Resources and Support

Official Texas Resources

Cigna-Specific Resources

  • Cigna Appeals and Grievances: Member portal and phone support
  • Express Scripts/Accredo: 1-844-516-3319 for specialty pharmacy questions
  • Cigna Provider Relations: 1-800-88CIGNA for prescriber support

Clinical Guidelines and Evidence

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Insurance coverage varies by plan and individual circumstances. Always consult with your healthcare provider and insurance company for plan-specific requirements. For personalized assistance with prior authorization and appeals, consider working with coverage advocacy services like Counterforce Health that specialize in turning insurance denials into successful approvals.

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