The Cigna Health Assessment form is a prior authorization request built into Cigna's pharmacy services workflow. Providers use it to document Humira (adalimumab) eligibility for autoimmune conditions including rheumatoid arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Plaque Psoriasis, Crohn's Disease, Ulcerative Colitis, and Juvenile Idiopathic Arthritis. Cigna uses the submitted data to determine whether Humira meets medical necessity criteria for that patient.
Providers must show that the patient tried at least one conventional disease-modifying antirheumatic drug (DMARD) before Humira is approved. Required documentation includes ICD-10 diagnosis codes, prior treatment history and outcomes, current disease activity scores, and the physician's clinical rationale. Forms are submitted by secure fax per Cigna's HIPAA-compliant transmission guidelines. Standard review takes 3 to 7 business days. Urgent reviews take 24 to 72 hours when the prescriber documents medical urgency.
| Question | Answer |
|---|---|
| Form Name | Cigna Health Assessment Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | cigna humira pa form, cigna health risk assessment form, cigna prior authorization form, cigna humira form |