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

Renewing Signifor / Signifor LAR (Pasireotide) Approval with Cigna in Virginia: 2025 Requirements, Timeline & Evidence Guide

Answer Box: Renewing Your Signifor LAR Coverage

Cigna typically approves Signifor LAR renewals for 12 months when you demonstrate ongoing clinical response. For Cushing's disease, you'll need recent UFC (urinary free cortisol) showing reduction from baseline. For acromegaly, provide age-adjusted IGF-1 normalization or GH <1.0 mcg/L plus clinical improvement evidence. Start your renewal 30-45 days before expiration to avoid treatment gaps. Submit through your endocrinologist with updated lab results, adherence documentation (≥85%), and absence of intolerable side effects. If denied, Virginia's external review process provides binding appeals within 120 days of final internal denial.

Table of Contents

When to Start Your Renewal

Begin your renewal process 30-45 days before your current authorization expires. Cigna's specialty drug approvals typically last 12 months, but you'll want to check your exact expiration date on your most recent prior authorization approval letter.

Early Warning Signs to Act Now

  • Your Accredo or Express Scripts specialty pharmacy contacts you about upcoming expiration
  • You receive a 30-day supply instead of your usual 90-day fill
  • Your endocrinologist's office mentions renewal during routine visits
  • You're approaching your annual lab monitoring schedule
Tip: Set a calendar reminder 60 days before expiration to schedule your renewal labs and endocrinology visit.

Required Evidence for Response

Your renewal hinges on proving Signifor LAR continues to benefit your condition. The specific evidence depends on your diagnosis.

For Cushing's Disease

Primary Evidence:

  • 24-hour urinary free cortisol (UFC) showing reduction from baseline or normalization
  • Late-night salivary cortisol or serum cortisol trends
  • Documentation of clinical symptom improvement

Supporting Documentation:

  • Blood pressure readings and cardiovascular improvements
  • Weight management progress
  • Mood and energy level assessments
  • Photos showing physical changes (if applicable)

For Acromegaly

Primary Evidence:

  • Age-adjusted IGF-1 levels within normal range
  • Growth hormone (GH) levels <1.0 mcg/L (some policies accept <1.9 U/mL for males, <2.2 U/mL for females)
  • Clinical improvement documentation

Supporting Documentation:

  • Tumor size measurements via MRI (if applicable)
  • Headache frequency and severity logs
  • Joint pain and mobility assessments
  • Sleep apnea improvements
Note: Cigna's policy requires evidence of positive clinical response with laboratory confirmation and absence of intolerable toxicity.

Your Renewal Documentation Packet

Must-Include Documents

  1. Updated Prior Authorization Form - Your endocrinologist completes this
  2. Recent Lab Results (within 3-6 months):
    • UFC or cortisol levels (Cushing's)
    • IGF-1 and/or GH levels (acromegaly)
  3. Clinical Progress Notes from your endocrinologist
  4. Adherence Documentation - pharmacy records showing ≥85% compliance
  5. Adverse Event Assessment - documenting tolerability

Letter of Medical Necessity Structure

Your endocrinologist should include:

Problem Statement: Current diagnosis with ICD-10 codes

  • Cushing's disease: E24.0 (pituitary-dependent)
  • Acromegaly: E22.0

Treatment History: Previous therapies tried and outcomes

Current Response: Specific lab improvements and clinical benefits

Continued Need: Why Signifor LAR remains medically necessary

Monitoring Plan: Ongoing safety and efficacy assessments

Submission Timeline & Decision Windows

Standard Timeline

Step Timeframe Action Required
Initial Submission 30-45 days before expiration Endocrinologist submits renewal request
Cigna Review 15 business days Standard prior authorization review
Decision Notice Within 72 hours of decision Approval/denial notification
Appeal Window 180 days from denial Internal appeal deadline

Expedited Process

For urgent situations where treatment interruption could cause serious harm, request expedited review:

  • Timeline: 72 hours for decision
  • Trigger: Medical emergency or immediate health risk
  • Documentation: Physician attestation of urgency required
Important: Virginia law requires expedited external review within 72 hours for urgent medical necessity cases.

If Your Approval Lapses

Immediate Actions

  1. Contact Cigna immediately at the number on your member ID card
  2. Request retroactive coverage if the delay wasn't your fault
  3. Ask about emergency supplies through your specialty pharmacy
  4. File an expedited appeal if medically urgent

Bridge Therapy Considerations

For Hyperglycemia Management:

  • Continue diabetes medications as prescribed
  • Monitor blood glucose more frequently during gaps
  • Metformin and low-hypoglycemia-risk medications can often continue safely

For Disease Control:

  • Work with your endocrinologist on temporary symptom management
  • Consider dose reduction rather than complete discontinuation if partial supply available
  • Monitor for symptom recurrence requiring urgent intervention
From our advocates: We've seen patients successfully obtain retroactive coverage when they can document that renewal submissions were timely but processing delays occurred on the insurer's end. Keep detailed records of all submission dates and communications.

Annual Formulary Changes to Watch

2025 Cigna Updates for Virginia

Cigna's 2025 formularies continue to classify pasireotide as a specialty tier medication, requiring:

  • Prior authorization
  • Specialty pharmacy dispensing only
  • Highest cost-sharing tier (Tier 4/5)

What to Verify Annually

Coverage Status: Confirm pasireotide remains on your plan's formulary

Tier Placement: Check if cost-sharing has changed

Restrictions: Review any new prior authorization requirements

Network Changes: Verify your specialty pharmacy is still in-network

Plan Options: Compare alternative Cigna plans during open enrollment (October 15 - December 7 for Medicare)

Personal Progress Tracker

Renewal Checklist

90 Days Before Expiration:

  • Schedule endocrinology appointment
  • Order renewal lab work
  • Review current approval letter for specific requirements

60 Days Before:

  • Complete lab work
  • Attend endocrinology visit
  • Collect pharmacy adherence records

30 Days Before:

  • Confirm renewal submission by provider
  • Follow up on any missing documentation
  • Set up tracking for decision timeline

Decision Received:

  • Review approval terms and expiration date
  • File appeal if denied
  • Update calendar for next renewal cycle

Appeals Process in Virginia

Internal Appeals with Cigna

Timeline: 180 days from denial notice Process:

  1. Submit written appeal with additional clinical evidence
  2. Request peer-to-peer review with medical director
  3. Provide updated labs or specialist consultation if available

External Review Through Virginia

After exhausting internal appeals, Virginia's Bureau of Insurance offers binding external review:

Timeline: 120 days from final internal denial Form: Form 216-A External Review Request Cost: Free to patients Decision: 45 days standard, 72 hours expedited Contact: 1-877-310-6560 for guidance

The external review is conducted by independent medical experts and is binding on Cigna if they overturn the denial.

When dealing with complex medication appeals like Signifor LAR, Counterforce Health specializes in turning insurance denials into targeted, evidence-backed appeals by analyzing denial letters, plan policies, and clinical notes to craft point-by-point rebuttals aligned with payer requirements.

FAQ

How long does Cigna prior authorization take for Signifor LAR renewals? Standard reviews take 15 business days, while expedited reviews are completed within 72 hours for urgent cases.

What if my IGF-1 levels aren't perfectly normal but I'm clinically improved? Document clinical improvements like reduced headaches, better sleep, or tumor size reduction. Some policies accept clinical response even with partial biochemical response.

Can I switch from Signifor to Signifor LAR during renewal? Yes, but this may require a new prior authorization rather than a simple renewal. Work with your endocrinologist to justify the formulation change.

Does step therapy apply to Signifor LAR renewals? Generally no for renewals if you're already established on therapy. Step therapy typically applies to new starts requiring trial of first-generation somatostatin analogs first.

What happens if Cigna removes Signifor LAR from formulary? You can request a formulary exception with medical necessity documentation. Virginia law requires notice of significant formulary changes.

How do I prove 85% adherence if I had supply interruptions? Document the reasons for interruptions (prior auth delays, pharmacy stock issues) and show consistent refill patterns when medication was available.

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 plan for personalized guidance. Coverage policies and requirements may change; verify current information with official sources.

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