Cigna · Daa Retreatment Vosevi · US health-plan appeal rights

Daa Retreatment Vosevi denied for failing step therapy by Cigna?

Q: How long do I have to appeal a Cigna Daa Retreatment Vosevi denial?

Internal appeal window: Typically 180 days from the denial date. External review window: Typically 60–120 days after the final internal denial. The clock starts from the date on the denial letter.

Step-therapy denials usually flip when the appeal documents that prior alternatives were tried and failed, or were contraindicated, or aren't safe for the patient.

By Michael John Ryan, Founder & Privacy Officer, DenialHelp, LLC

Last reviewed 2026-05-10

Policy data current as of 2026-04-26

US health-plan appeal rights

Cite: Most US health plans have appeal rights under either the ACA, ERISA, or Medicare/Medicaid rules

Most US health plans are required by federal law to give you both an internal appeal (where the insurer reconsiders) and an external review (where an independent reviewer decides). The exact timelines and processes depend on what kind of plan you have — marketplace / employer group, self-funded, Medicare Advantage, or Medicaid MCO — but in every case there's a window after the denial during which you have the right to fight it.

Internal appeal window

Typically 180 days from the denial date

External review window

Typically 60–120 days after the final internal denial

What Cigna typically requires

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.

Source policy: Cigna coverage policy - Hepatitis C DAA / Express Scripts Hepatitis C Coverage Policy

The Cigna angle on Daa Retreatment Vosevi

## Why Cigna Issues Step-Therapy Denials for Vosevi (DAA Retreatment)

Vosevi (sofosbuvir/velpatasvir/voxilaprevir) occupies a specialized position in the hepatitis C treatment landscape: it is indicated for patients who have already tried and failed an earlier DAA-based regimen. Cigna's step-therapy protocol is designed to require lower-cost first-line agents before approving advanced options. However, if you have already completed a prior DAA course and experienced failure, relapse, or intolerance, you have — by definition — already taken the "step" the policy requires. The denial commonly occurs when the prior treatment history is not clearly communicated to Cigna's utilization-management system at the time of the request.

## Why This Denial Is Appealable

Step-therapy requirements cannot lawfully compel a patient to repeat a treatment class they have already tried and failed. Most states have enacted step-therapy override laws requiring insurers to grant an exception when a patient has previously tried a required step-drug and it was ineffective, caused an adverse reaction, or is contraindicated per the prescriber's judgment. Even in states without explicit override statutes, Cigna's own step-therapy exception process and ACA internal-appeal rights provide a clear pathway. Your argument is straightforward: the step has been completed; forcing re-trial would be clinically inappropriate.

## Federal Appeal Framework

Internal appeal: File within the timeframe on your denial notice. For pre-service denials, Cigna must respond within 30 days (non-urgent) or 72 hours (urgent/expedited).
State step-therapy override request: File simultaneously with the internal appeal if your state has a step-therapy protection law. Your prescriber must attest that the required prior step was tried and failed, is contraindicated, or is otherwise clinically inappropriate.
External review (ACA §2719): If the internal appeal is denied, request independent external review within approximately four months of the final denial. An external reviewer applies clinical standards independently of Cigna.

## Documentation to Gather

1. Prior DAA treatment records — prescription fill history, pharmacy records, and treating-provider notes documenting the specific prior DAA regimen, duration, and outcome (treatment failure, relapse, intolerance). 2. Virologic response labs — end-of-treatment and post-treatment viral load results demonstrating the outcome of the prior regimen. 3. Current diagnosis and staging — genotype, subtype, and current fibrosis/liver-function documentation. 4. Prescriber letter addressing step-therapy — your specialist should explicitly state that the required step-therapy drugs have been tried (with dates) and why re-trial would be clinically inappropriate, citing the FDA label for Vosevi and relevant AASLD/IDSA retreatment guidance.

## Criteria-Mapping Structure

Obtain Cigna's step-therapy/prior-authorization policy for Vosevi. Map each stated step requirement to the documented history:

| Step-Therapy Requirement | Chart/Record Evidence | |---|---| | Prior DAA regimen required before Vosevi | [drug name, dates, prescriber] | | Evidence of prior DAA failure/relapse | [SVR12 lab result confirming failure] | | Retreatment indication per FDA label | [prescriber attestation to label criteria] | | No appropriate alternative exists | [specialist clinical judgment statement] |

A prescriber-signed letter that maps prior treatment history to each step-therapy criterion — and explains why forcing re-trial is inappropriate — is the strongest possible appeal document.

Next steps

Find the date on the denial letter — your appeal window starts there.
Read your plan's Summary of Benefits and Coverage (SBC) for the specific deadlines.
Request the insurer's claim file in writing — they must provide it.
Submit your appeal in writing with new clinical evidence and a physician statement.

Get the letter drafted

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Related appeal guides

Other Cigna appeals

Other denial reasons for Cigna Daa Retreatment Vosevi

denied as not medically necessary denied as non-formulary denied for missing prior authorization denied as experimental or investigational denied as not FDA-approved for this use

This guide describes general US federal appeal rights based on Most US health plans have appeal rights under either the ACA, ERISA, or Medicare/Medicaid rules. Your specific plan documents (Summary of Benefits and Coverage, Evidence of Coverage) override anything here. DenialHelp is not your lawyer and not your physician — we draft appeal letters that your physician signs. Outcomes depend on your insurer's decision and factors outside our control. Reviewed by Michael John Ryan on 2026-05-10. Editorial standards: denialhelp.com/authors.