Daa Retreatment Vosevi denied for missing prior authorization 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 Requires Prior Authorization for Vosevi

Prior authorization (PA) for Vosevi (sofosbuvir/velpatasvir/voxilaprevir) is standard for specialty DAA therapy across commercial insurers. Cigna's PA criteria for retreatment DAA therapy are designed to confirm that the prescribing is consistent with the drug's approved indication and professional society guidance: that the patient has a confirmed hepatitis C diagnosis, has received prior DAA-based treatment, has documented virologic failure or relapse, and currently has active HCV infection. A PA denial typically means one or more of these documentation requirements was not met in the initial submission — not that coverage is categorically unavailable.

## Why This Denial Is Appealable

PA denials are the most commonly reversed denial type because the documentation deficiency is curable. If the original PA submission was incomplete, the appeal is the opportunity to provide what was missing. If the PA was complete but denied, the appeal allows the prescriber to respond directly to the stated clinical objection. Either way, a well-constructed appeal that maps the medical record to each of Cigna's stated criteria has a strong reversal rate for an FDA-approved retreatment indication.

## Federal Appeal Framework

• Internal appeal (ERISA §503 / ACA §2719): File within the deadline on the denial letter. ERISA §503 guarantees a full-and-fair review for employer-sponsored plans; ACA §2719 applies to individual and small-group plans. Both require Cigna to consider clinical evidence submitted during appeal.
• Expedited appeal: If your prescriber documents that the standard timeline would seriously jeopardize your health, request expedited internal review (often 72-hour turnaround for urgent cases).
• External review: Available after a final internal denial under ACA §2719. File within approximately four months of the final internal determination. Expedited external review available when medically urgent.

## Concrete Appeal Steps

1. Request Cigna's written PA criteria for Vosevi and retreatment DAA therapy — Cigna is required to provide this. 2. Compare every criterion in that document to the medical record; identify which criteria were not satisfied in the original PA. 3. Obtain updated chart documentation, specialist notes, or lab results to fill any gaps. 4. Have your prescriber write a medical-necessity letter that addresses each PA criterion by name and cites the supporting chart evidence. 5. Submit the internal appeal with the criteria-mapping table, prescriber letter, and chart excerpts. 6. If denied internally, file external review immediately.

## Documentation to Gather

• Diagnosis: confirmed HCV genotype and active HCV RNA result
• Prior DAA treatment records: treatment name, start/end dates, and post-treatment HCV RNA confirming virologic failure or relapse
• Liver disease staging: current fibrosis or cirrhosis documentation
• Resistance testing: NS5A resistance-associated substitution testing if performed or clinically indicated per guidelines
• Prescriber PA appeal letter: maps each Cigna criterion to a specific chart finding with source document cited
• Current AASLD/IDSA retreatment guideline excerpt supporting the prescribed regimen

## Criteria-Mapping Structure

Obtain Cigna's PA criteria verbatim. Build a three-column table: Criterion | Chart Finding | Source (document name, date, page). Every criterion must have an entry. Where a criterion is clearly met, cite the specific evidence. Where a criterion requires clinical judgment (e.g., why a particular retreatment regimen was chosen), have the prescriber address it directly in the medical-necessity letter. A complete, well-organized criteria-mapping table is the single most effective document in a PA appeal.