Imcivree (setmelanotide subcutaneous injection) — Cigna

Reauthorization criteria

• Patient is ≥ 2 years of age; AND
• Patient meets ONE of the following (a or b): a) Patient has lost ≥ 5% of baseline body weight since initiating Imcivree therapy; OR b) Patient meets BOTH of the following: (1) Patient is < 18 years of age; AND (2) Patient has lost ≥ 5% of baseline BMI since initiating Imcivree therapy; AND
• The medication is prescribed by or in consultation with an endocrinologist, a geneticist, or a physician who specializes in metabolic disorders.