Daa Retreatment Vosevi denied as not medically necessary 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 for Medical Necessity

Medical-necessity denials for Vosevi (sofosbuvir/velpatasvir/voxilaprevir) are among the most common and most reversible denials for retreatment DAA therapy. Cigna's medical necessity criteria for Vosevi typically include confirmation of prior DAA-based treatment, documentation of virologic failure or relapse, current active hepatitis C infection, and in some cases specific requirements about genotype, resistance testing, or liver disease severity. Denials in this category almost always reflect documentation gaps in the prior-authorization submission rather than a genuine clinical disagreement about whether retreatment is appropriate.

## Why This Denial Is Appealable

Vosevi is the only FDA-approved pangenotypic retreatment option for patients who have failed a prior NS5A inhibitor-containing regimen, and it is endorsed by current AASLD/IDSA HCV guidance for retreatment scenarios. When the medical record thoroughly documents the retreatment indication, medical-necessity appeals succeed at high rates. The key is completeness: the appeal must map each of Cigna's stated criteria to the specific chart evidence.

## Federal Appeal Framework

• Internal appeal (ACA §2719 / ERISA §503): Submit within the deadline on your denial letter. Under ERISA §503, Cigna must provide a full-and-fair review that considers all clinical information you submit — including information not submitted with the original PA request.
• Expedited internal appeal: If your physician certifies that standard timelines would seriously jeopardize your health, request expedited review.
• External review: Available under ACA §2719 after a final internal denial. File within approximately four months. Expedited external review is available for urgent cases (often 72-hour turnaround).

## Concrete Appeal Steps

1. Request Cigna's written coverage/medical necessity policy for Vosevi and retreatment DAA therapy. 2. Read each criterion in that policy and locate the corresponding entry in the medical record for every criterion. 3. Identify any gaps — criteria for which documentation was not submitted in the original PA — and fill those gaps with updated chart notes or new specialist documentation before submitting the appeal. 4. Have the prescriber write a focused medical-necessity letter that addresses each criterion point by point. 5. Submit the internal appeal with the prescriber letter, the criteria-mapping table, and the supporting record excerpts. 6. If denied internally, file external review immediately.

## Documentation to Gather

• Prior DAA treatment records: treatment name, dates, and HCV RNA results confirming virologic failure or relapse after completion
• Current virology: HCV RNA confirming active infection; genotype and, if performed, resistance/NS5A resistance-associated substitution testing
• Liver disease staging: current fibrosis or cirrhosis assessment
• Prescriber medical-necessity letter: addresses Cigna's criteria point by point
• Current AASLD/IDSA HCV retreatment guideline excerpt supporting the specific retreatment regimen

## Criteria-Mapping Structure

This is the most important document in a medical-necessity appeal. Obtain Cigna's criteria verbatim. Build a table: Criterion | Chart Evidence | Source Document. Every criterion must have an answer. Criteria that are fully met should cite a specific chart date and finding. If a criterion is not applicable to your patient (e.g., a resistance-testing requirement in a scenario where testing was not clinically indicated), explain why in the table rather than leaving it blank. Completeness is the deciding factor.