CommercialReimbursementMedium impact
Specialty Medical Injectables with Reimbursement Restriction
Cigna·Oncology, Hematology, Endocrinology·Pharmacy
Effective date
Feb 9, 2026
We identified it
Jun 18, 2026
Summary
Cigna Healthcare has expanded their list of specialty medical injectables that must be dispensed by contracted specialty pharmacies when administered in outpatient hospital settings. The restriction does not apply when these drugs are administered in provider offices, non-hospital-affiliated ambulatory infusion suites, or home settings.
Action Required
Immediately: Billing team must verify that specialty medical injectable claims for outpatient hospital administration use Cigna Healthcare-contracted specialty pharmacies for the 11 newly added drugs (including LUNSUMIO VELO, RYBREVANT FASPRO, FOLOTYN, etc.). Review the complete list at CignaforHCP.com under Reimbursement and Payment Policies. Note that provider office, non-hospital ambulatory infusion suite, and home administration are not subject to this restriction. Monitor the list regularly as new injectables may be added upon FDA approval.