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

Work With Your Doctor to Get Signifor/Signifor LAR (Pasireotide) Approved by Cigna in Ohio: Complete Provider Partnership Guide

Answer Box: Getting Cigna to Cover Signifor/Signifor LAR in Ohio

Eligibility: Cigna covers Signifor/Signifor LAR (pasireotide) for adults with Cushing's disease when surgery isn't an option or wasn't curative, and for acromegaly after failing first-generation somatostatin analogs. Fastest path: Have your endocrinologist submit prior authorization through Express Scripts/Evernorth with complete biochemical documentation, surgical history, and step therapy compliance. Start today: Call Cigna at the number on your card to confirm specialty pharmacy requirements and gather your treatment timeline for your next appointment.

Table of Contents

  1. Set Your Goal: What Approval Requires
  2. Visit Prep: Building Your Clinical Story
  3. Evidence Kit: Essential Documentation
  4. Medical Necessity Letter Structure
  5. Peer-to-Peer Support Strategy
  6. After-Visit Follow-Through
  7. Respectful Persistence Framework
  8. Appeals Playbook for Ohio
  9. Common Denial Reasons & Fixes
  10. FAQ

Set Your Goal: What Approval Requires

Getting Cigna to approve Signifor or Signifor LAR requires meeting specific clinical criteria and following their utilization management process. Here's what you're working toward with your endocrinologist:

Coverage Requirements at a Glance

Requirement What It Means Where to Find It
Prior Authorization Required for all plans Cigna Provider Portal
Specialist Prescriber Must be endocrinologist or specialist experienced in Cushing's/acromegaly Cigna Pasireotide Policy
Specialty Pharmacy Express Scripts/Accredo required Express Scripts PA FAQ
Step Therapy (Acromegaly) Must fail octreotide/lanreotide first Cigna Pasireotide LAR Policy
Biochemical Evidence Elevated UFC (Cushing's) or IGF-1 (acromegaly) Cigna PA Requirements

Your partnership with your endocrinologist is crucial because Cigna requires specialist involvement and comprehensive documentation that only your treating physician can provide.

Visit Prep: Building Your Clinical Story

Before your appointment, organize your medical history to help your endocrinologist build the strongest possible case:

Symptom Timeline Documentation

Create a chronological summary including:

  • Initial symptoms and when they started (fatigue, weight changes, visual problems, etc.)
  • Diagnosis date and how it was confirmed (labs, imaging, pathology)
  • Functional impact on work, daily activities, and quality of life
  • Current symptoms and severity despite treatment

Treatment History Summary

Document every therapy you've tried:

For Cushing's Disease:

  • Pituitary surgery (date, outcome, complications)
  • Medical therapies (ketoconazole, osilodrostat, mifepristone)
  • Doses, duration, and reasons for stopping

For Acromegaly:

  • Pituitary surgery details
  • First-generation somatostatin analogs (octreotide LAR, lanreotide)
  • Exact doses, duration, IGF-1 response, side effects
  • Other therapies (pegvisomant, cabergoline)
Tip: Bring pharmacy records or pill bottles to verify exact medications and doses tried.

Side Effects and Contraindications

List specific adverse effects that led to treatment changes:

  • Severe GI intolerance
  • Gallbladder complications
  • Cardiac issues (bradycardia, QT prolongation)
  • Injection site reactions
  • Metabolic complications

This documentation helps justify why standard alternatives aren't appropriate for you.

Evidence Kit: Essential Documentation

Work with your endocrinologist's office to gather these critical documents before the prior authorization submission:

Laboratory Evidence

Cushing's Disease:

  • Recent 24-hour urinary free cortisol (UFC) levels with upper limit of normal
  • Late-night salivary cortisol results
  • ACTH levels confirming pituitary-dependent disease
  • Dexamethasone suppression test results

Acromegaly:

  • IGF-1 levels with age/sex-adjusted reference ranges
  • Growth hormone suppression test (OGTT) results
  • Serial IGF-1 trends showing inadequate response to prior therapies

Imaging and Surgical Records

  • Pituitary MRI reports showing adenoma or post-surgical changes
  • Operative notes from pituitary surgery
  • Pathology reports confirming somatotroph or corticotroph adenoma
  • Neurosurgical consultation notes if surgery was deemed inappropriate

Published Guidelines Support

Your endocrinologist should reference these in the medical necessity letter:

Medical Necessity Letter Structure

The medical necessity letter is the cornerstone of your prior authorization. Here's the structure your endocrinologist should follow:

Opening: Clear Problem Statement

"This 45-year-old patient with biochemically confirmed Cushing's disease requires pasireotide (Signifor) as pituitary surgery was not curative, evidenced by persistent UFC elevation at 3.2× upper limit of normal despite 18 months post-operatively."

Clinical Rationale Section

  1. Diagnosis confirmation with specific lab values and dates
  2. Surgical history and outcomes with objective measures
  3. Prior medical therapy failures with doses, duration, and reasons for discontinuation
  4. Current disease activity with recent biochemical evidence
  5. Risks of delayed treatment (cardiovascular, metabolic, skeletal complications)

Guideline Citations

Reference specific sections of:

  • FDA labeling for the requested indication
  • Cigna's own coverage criteria showing how the patient meets requirements
  • Professional society guidelines supporting this treatment choice

Monitoring Plan

Detail the follow-up schedule:

  • Laboratory monitoring intervals (UFC, IGF-1, glucose, liver enzymes)
  • Imaging schedule for tumor surveillance
  • Clinical assessment frequency
  • Treatment goals and success metrics

Peer-to-Peer Support Strategy

If Cigna requests a peer-to-peer review, you can support your endocrinologist's preparation:

Availability Windows

Provide your doctor's office with:

  • Your contact information for urgent questions
  • Flexible scheduling if you need to be available during the call
  • Permission to discuss your case details with Cigna medical directors

Concise Case Summary

Help prepare a one-page summary including:

  • Key lab values with reference ranges
  • Treatment timeline with objective outcomes
  • Specific reasons why alternatives failed or are contraindicated
  • Clear statement of treatment goals

Counterforce Health specializes in helping patients and providers navigate complex prior authorization cases like this, turning insurance denials into targeted, evidence-backed appeals by identifying the specific denial basis and crafting point-by-point rebuttals aligned to the plan's own rules.

After-Visit Follow-Through

Documentation to Save

Request copies of:

  • Prior authorization submission with all attachments
  • Confirmation number and submission date
  • Expected timeline for Cigna's decision
  • Backup plan if initial request is denied

Portal Communication

Use your patient portal to:

  • Message questions about the PA status
  • Request updates if timelines are exceeded
  • Share additional information that might strengthen the case

Prescription Coordination

Ensure your endocrinologist coordinates with:

Respectful Persistence Framework

Update Cadence

  • Week 1: Confirm PA submission and tracking number
  • Week 2: Check status if no response (standard timeframe is 72 hours for most requests)
  • Week 3+: Escalate if determination is overdue

Escalation Strategy

  1. Provider services line for status updates
  2. Member services if provider line is unresponsive
  3. Expedited review request if clinically urgent
  4. Internal appeal if denied

Professional Communication

When calling Cigna:

  • Reference your member ID and case number
  • Ask specific questions: "What additional information is needed?"
  • Document call dates, representatives' names, and next steps
  • Remain courteous but persistent about timelines

Appeals Playbook for Ohio

If Cigna denies coverage, Ohio residents have specific rights and timelines:

Internal Appeals Process

First Level:

  • Timeline: 180 days from denial to file appeal
  • Review period: Generally 30 days for standard, 72 hours for expedited
  • How to file: Written request to Cigna with supporting documentation

Second Level:

  • Available if first appeal is denied
  • Same timeline and documentation requirements
  • Often includes peer-to-peer review opportunity

External Review Rights

Ohio law provides external review through the Ohio Department of Insurance (verify current process):

  • Eligibility: After exhausting internal appeals
  • Timeline: 180 days from final internal denial
  • Process: Independent medical experts review case
  • Decision: Binding on Cigna if overturned

Getting Help in Ohio

  • Ohio Department of Insurance Consumer Services: 1-800-686-1526
  • UHCAN Ohio: Nonprofit providing consumer assistance
  • External Review Request Forms: Available through ODI website

For self-funded employer plans, federal ERISA rules apply, but many voluntarily use external review processes.

Common Denial Reasons & Fixes

Denial Reason How to Overturn
"Not prescribed by specialist" Ensure endocrinologist is listed as prescriber; submit credentials if needed
"Inadequate surgical documentation" Provide operative notes, pathology reports, and post-op imaging
"Missing step therapy compliance" Document specific octreotide/lanreotide trials with doses, duration, outcomes
"Insufficient biochemical evidence" Submit recent UFC or IGF-1 with reference ranges and trending data
"Experimental or investigational" Cite FDA labeling and published guidelines supporting this indication

Each fix should include specific documentation referenced to Cigna's published criteria for pasireotide.

FAQ

How long does Cigna prior authorization take for Signifor in Ohio? Standard review is typically 72 hours after complete submission. Expedited review may be available for urgent cases within 24 hours.

What if Signifor is non-formulary on my Cigna plan? You can request a formulary exception with medical necessity documentation. The process is similar to prior authorization but may require additional justification for why formulary alternatives are inappropriate.

Can I request an expedited appeal if denied? Yes, if delay would seriously jeopardize your health or ability to regain maximum function. Your endocrinologist must document the clinical urgency.

Does step therapy apply if I failed these medications outside Ohio? Yes, documented treatment failures from other states are typically accepted if properly documented with specific doses, duration, and outcomes.

What are my costs once approved? Signifor LAR is typically on specialty tier with 20-40% coinsurance. Contact Cigna member services for your specific cost-sharing and check for manufacturer assistance programs.

When should I contact the Ohio Department of Insurance? If Cigna doesn't respond within stated timeframes, denies without proper review, or if you need help understanding your appeal rights in Ohio.

Through strategic collaboration with your endocrinologist and persistent but professional advocacy, most patients can successfully navigate Cigna's approval process for Signifor/Signifor LAR. Counterforce Health has seen that well-documented cases with proper specialist involvement and comprehensive appeals have significantly higher approval rates, especially when leveraging Ohio's consumer-friendly external review process.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Treatment decisions should be made in consultation with qualified healthcare providers. Insurance coverage policies may vary by plan and can change. Always verify current requirements with your insurer and consult with your healthcare team about the most appropriate treatment options for your specific situation.

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