Daa Retreatment Vosevi denied as duplicate or overlapping therapy by Cigna?

Cigna's specific coverage criteria for daa retreatment vosevi are defined in its own published medical/coverage policy and the FDA-approved prescribing label. A successful appeal documents that your medical records satisfy each criterion those sources list — confirmed diagnosis, any required prior treatments (with dates and outcomes), and clinical severity. If the exact criteria weren't included with your denial, request them in writing; your appeal then maps each requirement to the matching fact in your chart.

## Why Cigna Denied Vosevi as "Duplicate Therapy"

Vosevi (sofosbuvir/velpatasvir/voxilaprevir) is a salvage direct-acting antiviral indicated specifically for patients who have already received prior DAA-based hepatitis C treatment and need retreatment. A "duplicate therapy" denial from Cigna typically arises because a prior DAA is already on the patient's medication profile — the system flags the new prescription as overlapping with an existing or recent HCV treatment. This denial misunderstands Vosevi's clinical purpose: it is designed precisely for patients with a prior DAA history, and a retreatment indication is not duplicate therapy in any clinically meaningful sense.

## Why This Denial Is Appealable

The duplicate-therapy denial rests on a logical error: Vosevi's FDA approval covers retreatment after prior DAA failure, so the prior treatment history that triggers the denial is also the clinical justification for prescribing Vosevi. Documenting the sequence — prior DAA, documented treatment failure, and current prescription of Vosevi for retreatment — dismantles the duplicate-therapy rationale entirely.

## Federal Appeal Framework

• Internal appeal (ACA §2719 / ERISA §503): Submit within the deadline on the denial letter. Cigna must conduct a full-and-fair review.
• External review: Available after a final internal denial under ACA §2719. File within approximately four months of the final internal determination. Expedited review is available when medically urgent (often 72-hour turnaround).
• State insurance department complaint: A concurrent complaint can accelerate Cigna's internal timeline.

## Concrete Appeal Steps

1. Document the prior DAA treatment: drug name, start/end dates, and the documented virologic outcome (e.g., relapse or non-response confirmed by HCV RNA testing after end of treatment). 2. Have your prescriber write a letter explaining the retreatment rationale and distinguishing Vosevi's retreatment indication from the prior therapy — these are sequential, not simultaneous, treatments. 3. Attach the relevant section of the FDA prescribing information confirming the retreatment indication. 4. Submit the internal appeal with these documents, explicitly refuting the duplicate-therapy characterization. 5. If denied, file for external review immediately.

## Documentation to Gather

• Prior DAA treatment records: drug name, treatment dates, and end-of-treatment/post-treatment HCV RNA results confirming virologic failure or relapse
• Current HCV RNA confirming active viremia
• Prescriber letter: explains retreatment rationale and references FDA-approved retreatment indication
• FDA prescribing information for Vosevi: confirms retreatment indication
• Genotype/resistance testing results if available

## Criteria-Mapping Structure

Create a two-column table. Left column: Cigna's stated basis for the duplicate-therapy denial (quoted verbatim). Right column: the rebuttal — prior treatment (date, drug) + documented failure (date, HCV RNA result) + FDA label confirmation that Vosevi is indicated for this retreatment scenario. This sequential timeline makes the duplicate-therapy characterization factually untenable.