Paxlovid — Cigna
Treatment of mild to moderate COVID-19 in adults who are at high risk for progression to severe COVID-19, including hospitalization or death
Initial criteria
- Approve a one-time override for a second course of treatment (either one 30 tablet carton or one 20 tablet carton) if the patient meets BOTH of the following (A and B):
- A) Patient has a repeat diagnosis of COVID-19; AND
- B) At least 30 days have elapsed since completion of the initial course of Paxlovid for treatment of COVID-19.
Approval duration
one-time override