Our Specialty Medical Injectables with Reimbursement Restriction guidelines state that certain injectables must be dispensed and their claims must be submitted by a Cigna Healthcare–contracted specialty pharmacy, unless otherwise authorized by Cigna Healthcare.

The reimbursement restriction:

• Applies when the specialty medical injectable is administered in an outpatient hospital setting.
• Applies to specialty medical injectables covered under the customer’s medical benefit. Coverage is determined by the customer’s benefit plan.
• Does not apply when the specialty medical injectable is administered in a provider’s office, non-hospital-affiliated ambulatory infusion suite, or home setting.

Changes to the Specialty Medical Injectables with Reimbursement Restriction list

Recently, we updated the Specialty Medical Injectables with Reimbursement Restriction list to include the specialty medical injectables listed below.

• Avlayah^TM (tividenofusp alfa-eknm) effective April 20, 2026
• Wainua® prefilled syringe (eplontersen) effective May 13, 2026
• Lumvoa (veligrotug-vvze) effective July 14, 2026

Additional information

To access the Specialty Medical Injectables with Reimbursement Restriction list, log in to the Cigna for Health Care Professionals website (CignaforHCP.com)> Resources > Reimbursement and Payment Policies > Precertification Policies > List of Specialty Medical Injectables with Reimbursement Restriction.  We recommend you review this list frequently, as it is subject to change.  New to market specialty medical injectables may be added upon U.S. Food and Drug Administration approval.