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Specialty Medical Injectables with Reimbursement Restriction
Act
by Jan 1, 2027
Effective date
Not stated in the notice
Identified
Oct 10, 2026
Summary
Cigna Healthcare has expanded its Specialty Medical Injectables with Reimbursement Restriction list, requiring that certain injectables be dispensed and claims submitted through a Cigna-contracted specialty pharmacy when administered in outpatient hospital settings. One drug (Zanvastro) is already restricted as of September 28, 2026, and 11 additional drugs become restricted effective January 1, 2027. The restriction does not apply to injectables administered in provider offices, non-hospital ambulatory infusion suites, or home settings.
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What to do
by Jan 1, 2027 · 5 steps
01Billing and clinical staff must verify that all claims for the 11 newly restricted injectables (Blincyto, Datroway, Imdelltra, Jelmyto, Keytruda, Lynozyfic, Rylplazim, Talvey, Texcayli, Unloxcyt, Zusduri) administered in outpatient hospital settings are submitted exclusively through Cigna-contracted specialty pharmacies unless explicitly authorized by Cigna Healthcare.
02Immediately (for September 28, 2026 effective date): Verify that Zanvastro claims from outpatient hospital settings are being routed through a Cigna-contracted specialty pharmacy.
03Billing team should update internal protocols to distinguish between outpatient hospital administration (requires specialty pharmacy routing) and office/non-hospital ambulatory/home administration (no restriction).
04Review the full Specialty Medical Injectables with Reimbursement Restriction list regularly at CignaforHCP.com > Resources > Reimbursement and Payment Policies > Precertification Policies to identify any additional drug additions.
05Claims submitted outside this requirement may be denied or face reimbursement restrictions.
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 RestrictionMediumEffective Jul 14, 2026 · PharmacySpecialty Medical Injectables with Reimbursement RestrictionMediumEffective Feb 9, 2026 · PharmacyBrowse every Cigna change in the policy list