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Does Cigna Cover Finasteride? Coverage, Formulary Tier, Prior Auth, and Appeals

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6 linked public sourcesEditorial, sourcing, and corrections policy

At a glance

  • Cigna coverage / set by your plan's drug list entry for the prescribed strength
  • 1 mg product / Propecia, NDA 020788, approved 12/19/1997, male pattern hair loss, men only [1][3]
  • 5 mg product / Proscar, NDA 020180, approved 06/19/1992, symptomatic BPH [2][4]
  • Prescription status / both strengths are prescription-only [3][4]
  • Compounded finasteride / not FDA-approved; FDA does not verify safety, effectiveness or quality before marketing [5]

Two strengths, two coverage questions

Finasteride 1 mg is Propecia, approved 12/19/1997 under NDA 020788 [1]. The Propecia label indicates it for male pattern hair loss (androgenetic alopecia) in men only, states that efficacy in bitemporal recession has not been established, and says the drug is not indicated for women [3].

Finasteride 5 mg is Proscar, approved 06/19/1992 under NDA 020180 [2]. The Proscar label indicates it for symptomatic benign prostatic hyperplasia in men with an enlarged prostate, to improve symptoms and reduce the risk of acute urinary retention and of surgery, and states that it is not approved to prevent prostate cancer [4].

These are two separate applications with two separate indications, and the strength written on the prescription is what a drug list is checked against. HealthRX.com offers finasteride 1 mg by prescription.

Prior authorization, step therapy and appeals

Any prior authorization or step-therapy condition appears with the plan's drug list entry for the prescribed strength. If a claim is denied, check the denial notice for appeal instructions and deadlines. For job-based coverage, the Department of Labor has resources on claiming health benefits [6].

Compounded finasteride

Compounded drugs are not FDA-approved, and FDA does not verify their safety, effectiveness or quality before marketing [5]. A coverage question about finasteride therefore has to name the product: an FDA-approved 1 mg or 5 mg tablet and a compounded preparation are not the same thing [5].

Frequently asked questions

Does Cigna cover finasteride 1 mg for hair loss?
That depends on the plan's drug list entry for finasteride 1 mg, which is Propecia's strength, indicated for male pattern hair loss in men only and prescription-only [3].
Is 5 mg finasteride covered the same way as the 1 mg tablet?
They are separate approved products for separate indications: Proscar 5 mg for symptomatic BPH and Propecia 1 mg for male pattern hair loss [3][4]. The strength on the prescription determines which drug list entry applies.
Does Cigna cover compounded finasteride?
Compounded drugs are not FDA-approved, and FDA does not verify their safety, effectiveness or quality before marketing [5]. Whether a plan pays for a compounded preparation is a separate coverage decision.
How do I appeal a Cigna denial for finasteride?
Check the denial notice for appeal instructions and deadlines. For job-based coverage, the Department of Labor has resources on claiming health benefits [6].

References

  1. Drugs@FDA: FDA-Approved Drugs. Drugs@FDA: FDA-Approved Drugs
  2. Drugs@FDA: FDA-Approved Drugs. Drugs@FDA: FDA-Approved Drugs
  3. U.S. National Library of Medicine, DailyMed. Propecia (finasteride 1 mg) tablets, Organon prescribing information. Propecia (finasteride 1 mg) tablets, Organon label
  4. U.S. National Library of Medicine, DailyMed. Proscar (finasteride 5 mg) tablets, Organon prescribing information. Proscar (finasteride 5 mg) tablets, Organon label
  5. Compounding and the FDA: Questions and Answers | FDA. Compounding and the FDA: Questions and Answers | FDA
  6. Employee Benefits Security Administration | U.S. Department of Labor. Employee Benefits Security Administration | U.S. Department of Labor
Evidence overview for Does Cigna Cover Finasteride? Coverage, Formulary Tier, Prior Auth, and Appeals