All PlansPrior AuthMedium impact
Enhancement to medical oncology prior authorization requirements for MSI/MMR biomarker testing for rectal cancer
Cigna·Oncology·Prior Authorization
Effective date
Feb 14, 2025
We identified it
Jun 19, 2026
Summary
Starting February 14, 2025, Cigna Healthcare will require peer-to-peer discussions when providers request chemotherapy for rectal cancer patients with MSI-H biomarker test results, as NCCN guidelines now recommend immunotherapy for these cases. MSI/MMR biomarker testing remains required before submitting prior authorization requests for rectal cancer treatment.
Action Required
By February 14, 2025: Medical oncology team must be prepared for mandatory peer-to-peer discussions with EviCore medical oncologists when requesting chemotherapy prior authorization for rectal cancer patients with MSI-H biomarker results. Ensure MSI/MMR test results are documented and available during prior authorization submissions. Consider discussing immunotherapy options with patients who have MSI-H results before submitting chemotherapy requests.