How to appeal a Cigna asthma & severe allergies denial

The framework that applies to your appeal

Federal law gives you the right to a full and fair internal appeal, then an external review by an independent third party.

Cigna-specific note: Sold its Medicaid Advantage book to HCSC in 2023. Express Scripts (PBM) is Cigna-owned. Frequent class-action litigation around mental health parity.

What Cigna's policy requires for asthma & severe allergies

Cited policy: Cigna / Express Scripts Nucala / Fasenra PA — Eosinophil Threshold

Severe eosinophilic asthma. Nucala: blood eos >=150 at initiation OR >=300 within prior 12 mo. Fasenra: >=300 preferred. >=2 exacerbations in past 12 mo despite high-dose ICS/LABA.

How Cigna denies asthma & severe allergies — and how to counter it

Where Cigna pushes back: 1) Current eos count below threshold; 2) Insufficient exacerbation history.

Counter-arguments that hold up: Document peak historical eos BEFORE OCS suppression. Nucala PI explicitly allows >=150 + recent exacerbation pathway. Cite MENSA NEJM 2014 + DREAM Lancet 2012 + SIROCCO/CALIMA Lancet 2016 + ZONDA NEJM 2017. Nucala FDA Nov 4, 2015; Fasenra FDA Nov 14, 2017 (peds expansion Apr 2024).

What Cigna typically denies for asthma & severe allergies

Across Cigna's commercial and Medicare books, denials cluster around a small number of patterns. For asthma & severe allergies, expect:

• Mental health parity violations
• Step therapy
• Specialty drug prior auth
• OON balance billing disputes

Treatments most often denied in this category

These are the asthma & severe allergies treatments most often flagged for prior auth, step therapy, or medical necessity review:

• Xolair
• Dupixent (asthma)
• Nucala
• Fasenra
• Cinqair
• Tezspire

How to submit the appeal to Cigna

1. Read the denial letter — note the exact denial reason code and the appeal deadline (180 days from the date on the letter).
2. Gather supporting documentation: physician letter of medical necessity, relevant clinical notes, peer-reviewed citations supporting the treatment for your indication, and the policy or coverage document Cigna cited in the denial.
3. File the appeal through Cigna's portal (members: https://my.cigna.com ; providers: https://cignaforhcp.cigna.com). Standard decision returns within 30 days; expedited urgent appeals return within 72 hours.
4. If denied again, request external review by an independent reviewer within 4 months of the final internal denial. In CT, the state insurance department coordinates external review for fully-insured plans; ERISA self-funded plans use a federal external review through DOL/EBSA.

Clinician or prior-auth team handling this on the practice side? See Cigna's prior-authorization criteria by drug: Cigna PA criteria on ApprovalHelp.