By Counterforce Health Team in Brensocatib (BRINSUPRI) —

The Requirements Checklist to Get Brensocatib (BRINSUPRI) Covered by Cigna in Michigan

Answer Box: Getting Started in Michigan

Cigna requires prior authorization for Brensocatib (BRINSUPRI) with step therapy through macrolide antibiotics. Your pulmonologist submits via CoverMyMeds or fax (866-873-8279) with CT scan confirming bronchiectasis, documented exacerbations (≥2/year for adults), and failed macrolide trials. Standard approval takes 5-10 business days. If denied, you have 180 days for internal appeals, then 127 days for Michigan DIFS external review. Start today: Contact your specialist to gather documentation and submit the PA request through Cigna's provider portal.

Table of Contents

  1. Who Should Use This Checklist
  2. Member & Plan Basics
  3. Clinical Criteria Requirements
  4. Coding & Billing Essentials
  5. Documentation Packet
  6. Submission Process
  7. Specialty Pharmacy Setup
  8. After Submission: What to Expect
  9. Denial Prevention Tips
  10. Appeals Process in Michigan
  11. Printable Checklist

Who Should Use This Checklist

This guide is for Michigan residents with Cigna coverage who need Brensocatib (BRINSUPRI) for non-cystic fibrosis bronchiectasis. You'll need:

  • Active Cigna commercial, Medicare Advantage, or marketplace plan
  • Confirmed bronchiectasis diagnosis by chest CT
  • History of pulmonary exacerbations requiring antibiotics
  • A pulmonologist or infectious disease specialist managing your care

Expected outcome: With complete documentation, most PA requests are approved within 5-10 business days. If initially denied, properly prepared appeals have higher success rates, especially when rare disease evidence is provided.

Member & Plan Basics

Coverage Requirements

  • Active coverage verification: Check your Cigna member ID and confirm specialty drug benefits
  • Plan type: Commercial, Medicare Advantage, and marketplace plans all require PA
  • Deductible status: Specialty medications may apply to your deductible before copay assistance kicks in
  • Authorization scope: Approvals typically last 1 year with annual renewal required
Note: Cigna manages specialty drugs through Express Scripts/Accredo. Verify your plan includes specialty pharmacy benefits before starting the PA process.

Clinical Criteria Requirements

FDA-Approved Indication

Brensocatib is approved for non-cystic fibrosis bronchiectasis in patients ≥12 years old. Cigna's PA policy requires all of the following:

Requirement Details Documentation Needed
Age verification ≥12 years Birth date on prescription
Confirmed diagnosis Bronchiectasis by chest CT Radiology report
Exacerbation history ≥1 (ages 12-17) or ≥2 (≥18 years) in past 12 months Dates, antibiotics used
Exclusions ruled out No CF, COPD, or asthma as primary cause PFTs, diagnostic tests
Smoking status Current non-smoker Provider attestation
Prescriber qualification Pulmonologist or ID specialist NPI verification

Step Therapy Requirements

Cigna enforces step therapy through macrolide antibiotics before approving Brensocatib. Document:

  • Trial of azithromycin or other macrolide (dose, duration, outcome)
  • Reason for discontinuation (ineffective, intolerance, contraindication)
  • Specific dates and clinical response

Coding & Billing Essentials

ICD-10 Codes for Bronchiectasis

Use the most specific code based on clinical presentation:

  • J47.0: Bronchiectasis with acute exacerbation
  • J47.1: Bronchiectasis with acute lower respiratory infection
  • J47.9: Bronchiectasis, uncomplicated

HCPCS and NDC Codes

  • Primary billing: NDC code through specialty pharmacy benefit
  • Medical benefit (rare): J3490 (unclassified drugs) + NDC with "Brinsupri 25 mg tablet" description
  • Dosing: Document as 25 mg once daily (avoid mg/kg notation)

Documentation Packet

Provider Note Elements

Your specialist's clinical note should include:

  • Confirmed bronchiectasis diagnosis with imaging date
  • Detailed exacerbation history (dates, symptoms, treatments)
  • Previous macrolide therapy attempts and outcomes
  • Current symptoms and functional status
  • Treatment goals and monitoring plan

Medical Necessity Letter Components

The letter should address:

  1. Patient history: Diagnosis, symptom progression, impact on quality of life
  2. Prior treatments: Specific macrolides tried, doses, duration, and why they failed
  3. Clinical rationale: Why Brensocatib is medically necessary based on ASPEN trial data
  4. Guidelines: Reference ATS/ERS bronchiectasis management guidelines
  5. Monitoring: Plan for follow-up and safety monitoring

Required Attachments

  • Chest CT report confirming bronchiectasis
  • Pulmonary function tests (if available)
  • Records of previous antibiotic treatments
  • Documentation of macrolide trial/failure
  • Specialist consultation notes

Submission Process

Fastest Submission Methods (5-10 Business Days)

  1. Electronic PA (preferred): CoverMyMeds, SureScripts, or Cigna Provider Portal
  2. Fax: 1-866-873-8279 for standard PA requests
  3. Phone: 1-800-88-CIGNA for urgent/expedited requests (≤72 hours)

Required Forms

  • Cigna-specific PA form (available through provider portal)
  • Michigan accepts Texas Standard PA Request Form as alternative
  • Include all clinical documentation with initial submission
Tip: Electronic submissions through CoverMyMeds typically process faster and provide real-time status updates.

Specialty Pharmacy Setup

Accredo Enrollment Process

Brensocatib requires specialty pharmacy dispensing through Accredo:

  1. Prescriber completes enrollment form: Include patient details, clinical information, and prescribing details
  2. Fax to 888.302.1028: Form enters Accredo's system for processing
  3. Patient registration: Sign up at accredo.com or call 844.516.3319
  4. Insurance coordination: Accredo handles PA submission and insurance verification

Transfer From Retail

  • One-time 34-day retail fill allowed for urgent starts
  • Subsequent fills must go through Accredo
  • Prescriber initiates transfer by completing new enrollment form

After Submission: What to Expect

Status Tracking

  • Confirmation number: Record for all submissions
  • Check schedule: Business days 3, 7, and 10 after submission
  • Portal access: Monitor through Cigna provider portal or CoverMyMeds

Timeline Expectations

Request Type Standard Review Expedited Review
Standard PA 5-10 business days N/A
Urgent medical need N/A 72 hours
Formulary exception 1-2 business days 24 hours

When Counterforce Health helps patients navigate complex PA requirements, we've seen that complete initial submissions significantly reduce processing delays and the need for additional documentation requests.

Denial Prevention Tips

Five Common Pitfalls and Solutions

  1. Missing step therapy documentation
    • Fix: Include specific dates, doses, and outcomes for macrolide trials
  2. Incomplete exacerbation history
    • Fix: Document each exacerbation with date, symptoms, antibiotic used, and duration
  3. Wrong prescriber specialty
    • Fix: Ensure pulmonologist or infectious disease specialist submits the request
  4. Insufficient imaging documentation
    • Fix: Attach complete chest CT report, not just summary
  5. Generic medical necessity letter
    • Fix: Customize letter with patient-specific details and guideline references

Appeals Process in Michigan

Internal Appeals with Cigna

  • Deadline: 180 calendar days from denial notice
  • Timeline: 30 days for pre-service, 60 days for post-service reviews
  • Submission: Use Cigna appeals form
  • Include: Original denial letter, additional clinical evidence, updated medical necessity letter

Michigan DIFS External Review

If Cigna denies your internal appeal, you can request external review through Michigan's Department of Insurance and Financial Services:

  • Deadline: 127 days after final internal denial
  • Standard review: 60 days maximum
  • Expedited review: 72 hours with physician urgency letter
  • How to file: DIFS External Review Request online or by mail
  • Contact: 877-999-6442 for questions
From our advocates: We've seen Michigan external reviews succeed when appeals include peer-reviewed evidence specific to the patient's case, especially for rare diseases where few treatment alternatives exist. The key is demonstrating that standard treatments have failed and that the denied medication addresses the specific medical need.

When to Escalate

Contact Michigan DIFS Consumer Services if:

  • Cigna doesn't respond within required timeframes
  • You need help understanding your appeal rights
  • You want to file a complaint about the PA process

Printable Checklist

Before Submission

  • Verify active Cigna coverage with specialty benefits
  • Confirm pulmonologist/ID specialist as prescriber
  • Obtain chest CT report confirming bronchiectasis
  • Document ≥1 (ages 12-17) or ≥2 (≥18) exacerbations in past year
  • Record macrolide trial details (drug, dose, duration, outcome)
  • Gather PFTs and other diagnostic tests
  • Complete medical necessity letter with patient-specific details

Submission Day

  • Submit via CoverMyMeds or Cigna provider portal (preferred)
  • Include all required attachments
  • Record confirmation number and submission date
  • Set calendar reminders for status checks (days 3, 7, 10)

If Denied

  • Review denial reason carefully
  • Gather additional supporting evidence
  • Submit internal appeal within 180 days
  • If denied again, file DIFS external review within 127 days

Disclaimer: This information is for educational purposes and doesn't constitute medical advice. Always consult your healthcare provider about treatment decisions. For official Michigan insurance regulations, visit Michigan DIFS.

For patients and clinicians navigating complex insurance requirements, Counterforce Health provides tools and expertise to turn insurance denials into targeted, evidence-backed appeals that align with payer-specific policies and procedural requirements.

Sources & Further Reading

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