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Specialty Medical Injectables with Reimbursement Restriction
Act
by Jul 14, 2026
Effective date
Jul 14, 2026
Identified
Jul 30, 2026
Replaced. This version was replaced by Specialty Medical Injectables with Reimbursement Restriction (effective Oct 5, 2026).
Summary
Cigna Healthcare has added three new specialty medical injectables to their reimbursement restriction list, effective on staggered dates between April and July 2026. When these injectables are administered in outpatient hospital settings and covered under the medical benefit, claims must be submitted by a Cigna Healthcare–contracted specialty pharmacy. The restriction does not apply to provider offices, non-hospital ambulatory infusion suites, or home settings.
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What to do
by Jul 14, 2026 · 6 steps
01Billing team must verify which of the three newly restricted injectables (Avlayah, Wainua prefilled syringe, and Lumvoa) are used in your outpatient hospital setting.
02For claims involving these drugs administered in hospital outpatient departments, ensure they are submitted ONLY through a Cigna Healthcare–contracted specialty pharmacy unless otherwise authorized by Cigna.
03Update billing workflows and staff training to route hospital-based injectable claims for these drugs to specialty pharmacy channels.
04For the same drugs administered in your provider's office or non-hospital ambulatory infusion suite, continue standard billing processes as the restriction does not apply.
05Failure to route hospital claims through the contracted specialty pharmacy may result in claim denials.
06Billing team should regularly check CignaforHCP.com > Resources > Reimbursement and Payment Policies > Precertification Policies > List of Specialty Medical Injectables with Reimbursement Restriction for additional updates, as this list is subject to change with new FDA approvals.
Original notice
Specialty Medical Injectables with Reimbursement Restriction
providernewsroom.com · Always check the source before changing claims.
Related changes
See all Cigna changes →Specialty Medical Injectables with Reimbursement RestrictionMediumEffective Oct 5, 2026 · PharmacySpecialty Medical Injectables with Reimbursement RestrictionHighNo effective date · PharmacySpecialty Medical Injectables with Reimbursement RestrictionMediumEffective Feb 9, 2026 · PharmacyBrowse every Cigna change in the policy list