[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-563732-105":53,"doc-detail-563732-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","estrogens-topical-patches-drug-quantity-management-policy-per-days","Estrogens (Topical) - Patches Drug Quantity Management Policy - Per Days","","Drug Quantity Management Policy – Per Days for topical estrogen patch products administered under CIGNA health benefit plans. It lists covered estradiol transdermal patches (Climara, Menostar, Minivelle, Vivelle-Dot) with review date, utilization management instructions, and when coverage is not approved at point of service. The policy includes an overview of indications, an off-label section for ART and gender-affirming use, and dosing/availability details (strengths, package sizes, weekly frequency) with limits and denial rules based on covered diagnosis and procedure coding.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/estrogens-topical-patches-drug-quantity-management-policy-per-days/563732/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/estrogens-topical-patches-drug-quantity-management-policy-per-days/563732.png","ImageObject",442,249,{"name":88,"@type":89},"Supernature","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","2026-10-12",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Which estrogen patch products are covered under this quantity management policy?","Question",{"text":108,"@type":109},"The policy lists Climara, Menostar, Minivelle, and Vivelle-Dot (all estradiol transdermal patch products). It also notes generic and branded versions where applicable.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What happens if the drug quantity management rule is not met at the point of service?",{"text":113,"@type":109},"Coverage is determined by the criteria outlined in the policy. Reimbursement is limited to requested services submitted according to the relevant criteria, including covered diagnoses and/or procedure codes.",{"name":115,"@type":106,"acceptedAnswer":116},"Are estrogens covered for off-label uses under this policy?",{"text":117,"@type":109},"The document describes off-label use patterns (e.g., Assisted Reproductive Technology and hormone use for gender dysphoria). However, coverage still depends on submission according to the applicable policy criteria and covered coding requirements.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},563732,1792091299,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},962093270004,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","DRUG QUANTITY MANAGEMENT POLICY – PER DAYS  \nPOLICY: Estrogens (Topical)– Patches Drug Quantity Management Policy – Per Days  \n• Climara􀂓 (estradiol transdermal system [patch] – Bayer; generic)  \n• Menostar® (estradiol transdermal system [patch] – Bayer)  \n• Minivelle® (estradiol transdermal system [patch] – Noven; generic, Lyllana® )  \n• Vivelle-Dot® (estradiol transdermal system [patch] − Noven/Sandoz; generic, Dotti® )  \nREVIEW DATE: 01/05/2026  \nINSTRUCTIONS FOR USE  \nTHE FOLLOWING COVERAGE POLICY APPLIES TO HEALTH BENEFIT PLANS ADMINISTERED BY CIGNA COMPANIES. CERTAIN CIGNA COMPANIES AND/OR LINES OF BUSINESS ONLY PROVIDE UTILIZATION REVIEW SERVICES TO CLIENTS AND DO NOT MAKE COVERAGE DETERMINATIONS. REFERENCES TO STANDARD BENEFIT PLAN LANGUAGE AND COVERAGE DETERMINATIONS DO NOT APPLY TO THOSE CLIENTS. COVERAGE POLICIES ARE INTENDED TO PROVIDE GUIDANCE IN INTERPRETING CERTAIN STANDARD BENEFIT PLANS ADMINISTERED BY CIGNA COMPANIES. PLEASE NOTE, THE TERMS OF A CUSTOMER ’S PARTICULAR BENEFIT PLAN DOCUMENT [GROUP SERVICE AGREEMENT, EVIDENCE OF COVERAGE, CERTIFICATE OF COVERAGE, SUMMARY PLAN DESCRIPTION (SPD) OR SIMILAR PLAN DOCUMENT] MAY DIFFER SIGNIFICANTLY FROM THE STANDARD BENEFIT PLANS UPON WHICH THESE COVERAGE POLICIES ARE BASED. FOR EXAMPLE, A CUSTOMER ’S BENEFIT PLAN DOCUMENT MAY CONTAIN A SPECIFIC EXCLUSION RELATED TOA TOPIC ADDRESSED INA COVERAGE POLICY. IN THE EVENT OF A CONFLICT, A CUSTOMER ’S BENEFIT PLAN DOCUMENT ALWAYS SUPERSEDES THE INFORMATION IN THE COVERAGE POLICIES. IN THE ABSENCE OF A CONTROLLING FEDERAL OR STATE COVERAGE MANDATE, BENEFITS ARE ULTIMATELY DETERMINED BY THE TERMS OF THE APPLICABLE BENEFIT PLAN DOCUMENT. COVERAGE DETERMINATIONS IN EACH SPECIFIC INSTANCE REQUIRE CONSIDERATION OF 1) THE TERMS OF THE APPLICABLE BENEFIT PLAN DOCUMENT IN EFFECT ON THE DATE OF SERVICE; 2) ANY APPLICABLE LAWS/REGULATIONS; 3) ANY RELEVANT COLLATERAL SOURCE MATERIALS INCLUDING COVERAGE POLICIES AND; 4) THE SPECIFIC FACTS OF THE PARTICULAR SITUATION. EACH COVERAGE REQUEST SHOULD BE REVIEWED ON ITS OWN MERITS. MEDICAL DIRECTORS ARE EXPECTED TO EXERCISE CLINICAL JUDGMENT WHERE APPROPRIATE AND HAVE DISCRETION IN MAKING INDIVIDUAL COVERAGE DETERMINATIONS. WHERE COVERAGE FOR CARE OR SERVICES DOES NOT DEPEND ON SPECIFIC CIRCUMSTANCES, REIMBURSEMENT WILL ONLY BE PROVIDED IF A REQUESTED SERVICE(S) IS SUBMITTED IN ACCORDANCE WITH THE RELEVANT CRITERIA OUTLINED IN THE APPLICABLE COVERAGE POLICY, INCLUDING COVERED DIAGNOSIS AND/OR PROCEDURE CODE(S). REIMBURSEMENT ISNOT ALLOWED FOR SERVICES WHEN BILLED FOR CONDITIONS OR DIAGNOSES THAT ARE NOT COVERED UNDER THIS COVERAGE POLICY (SEE “CODING INFORMATION” BELOW). WHEN BILLING, PROVIDERS MUST USE THE MOST APPROPRIATE CODES AS OF THE EFFECTIVE DATE OF THE SUBMISSION. CLAIMS SUBMITTED FOR SERVICES THAT ARE NOT ACCOMPANIED BY COVERED CODE(S) UNDER THE APPLICABLE COVERAGE POLICY WILL BE DENIED AS NOT COVERED. COVERAGE POLICIES RELATE EXCLUSIVELY TO THE ADMINISTRATION OF HEALTH BENEFIT PLANS. COVERAGE POLICIES ARE NOT RECOMMENDATIONS FOR TREATMENT AND SHOULD NEVER BE USED AS TREATMENT GUIDELINES. IN CERTAIN MARKETS, DELEGATED VENDOR GUIDELINES MAY BE USED TO SUPPORT MEDICAL NECESSITY AND OTHER COVERAGE DETERMINATIONS.  \nCIGNA NATIONAL FORMULARY COVERAGE:  \nOVERVIEW  \nClimara (generic) and Vivelle-Dot (generic) are indicated for: 1,4  \n• Prevention of postmenopausal osteoporosis .  \n• Treatment of moderate or severe vasomotor symptoms associated with menopause.  \n• Moderate or severe vulvar/vaginal atrophy associated with menopause.  \n• Hypoestrogenism due to hypogonadism, castration (ovariectomy), or primary ovarian failure.  \nMinivelle (generic) is indicated for the treatment of:3  \n• Moderate to severe vasomotor symptoms due to menopause .  \n• Prevention of postmenopausal osteoporosis .  \nMenostar is the only estrogen patch product with the single indication for prevention of postmenopausal osteoporosis.2  \nDosing and Availability  \nTable 1. Strength and Dosing for Estrogen Patches.1-4  \n","cbCairW5BN6t08YO","https://ap.wps.com/l/cbCairW5BN6t08YO","pdf",226161,6,"English","# Overview\n## CIGNA National Formulary Coverage\n## Dosing and Availability\n## Off-Label Uses\n# Policy Statement\n## Program Purpose and Coverage Determination Rules\n## Reimbursement and Coding Requirements","[{\"question\":\"Which estrogen patch products are covered under this quantity management policy?\",\"answer\":\"The policy lists Climara, Menostar, Minivelle, and Vivelle-Dot (all estradiol transdermal patch products). It also notes generic and branded versions where applicable.\"},{\"question\":\"What happens if the drug quantity management rule is not met at the point of service?\",\"answer\":\"Coverage is determined by the criteria outlined in the policy. Reimbursement is limited to requested services submitted according to the relevant criteria, including covered diagnoses and/or procedure codes.\"},{\"question\":\"Are estrogens covered for off-label uses under this policy?\",\"answer\":\"The document describes off-label use patterns (e.g., Assisted Reproductive Technology and hormone use for gender dysphoria). However, coverage still depends on submission according to the applicable policy criteria and covered coding requirements.\"}]","Estrogens (Topical) - Patches Drug Quantity Management Policy - Per Days | PDF",1791837945]