Check Cigna’s online provider portal for the most up-to-date requirements. Their criteria frequently change, so relying on outdated information is risky.
Factors Influencing Approval
Cigna typically requires documentation demonstrating a genuine medical need for Viagra. This includes proof of diagnosed erectile dysfunction, attempts at lifestyle modifications (like weight loss and exercise), and a trial of other, less expensive treatments. They scrutinize the patient’s overall health and any potential drug interactions. Age and pre-existing conditions also play a role in their assessment.
Required Documentation
Prepare a clear and concise medical record outlining the diagnosis, treatment history, and justification for Viagra. Include details on other treatments tried and their effectiveness (or lack thereof). A clear explanation of the patient’s condition and why Viagra is the most appropriate treatment is vital. Specific details on unsuccessful attempts to treat the condition using alternative methods should also be included.
Utilizing the Prior Authorization Process
Submit all required documents electronically through Cigna’s provider portal whenever possible. This streamlines the process and often speeds up turnaround times. Phone calls should only be used for clarifying urgent queries.
Typical Denial Reasons
| Insufficient documentation | Resubmit with more detailed medical records and rationale. |
| Lack of documented attempts at alternative treatments | Provide evidence of trying and documenting other methods to address erectile dysfunction. |
| Pre-existing conditions contraindicating Viagra use | Consult with the patient’s physician to discuss alternative treatments. |
| Missing patient information | Verify accuracy of submitted information. |
Appealing a Denial
If Cigna denies your prior authorization request, review the denial reason carefully. If you feel the denial is unwarranted, gather any additional supporting evidence and submit a formal appeal following Cigna’s specific appeals process guidelines found on their provider portal.
