Tirosint-SOL — Cigna
Hypothyroidism
Preferred products
- levothyroxine sodium tablets (generics)
- Ermeza solution
Initial criteria
- Patient meets ONE of the following criteria (i or ii):
- i. Patient has tried one Step 1 Product (generic levothyroxine tablets, or brand Synthroid, or another brand of levothyroxine tablets such as Levoxyl); OR
- ii. Patient is unable to swallow or has difficulty swallowing tablets; AND
- Patient has tried the Step 2 Product (Ermeza solution)
Approval duration
1 year