Generic medications start with a lowercase letter and brand name medications start with a capital letter. 909015 UPDATED_10/12/2018 The medications listed below are changing coverage (or cost levels) on Cigna’s Prescription Drug List. Changes are listed by drug list name and by the date they begin. If you’re enrolled with Cigna, you can log into myCigna.com to find out how these changes may affect your specific plan. STANDARD (CIGNA NATIONAL) PRESCRIPTION DRUG LIST PRESCRIPTION DRUG LIST CHANGES Cigna Pharmacy Management ® 2018 Start date of change* Drug class Medication not covered^ Generic and/or preferred brand alternatives November 15, 2018 CANCER Yonsa Zytiga PAIN RELIEF AND INFLAMMATORY DISEASE Aimovig antiepileptic drugs, antidepressants, beta blockers November 1, 2018 INFECTIONS nitrofurantoin 25mg/ml oral suspension sulfamethoxazole-trimethoprim suspension, nitrofurantoin capsule September 1, 2018 SKIN CONDITIONS Doxepin 5% Cream generic topical steroid (e.g. betamethasone) or topical tacrolimus July 1, 2018 DIABETES Segluromet Synjardy, Synjardy XR, Xigduo XR Steglatro Farxiga, Jardiance Steglujan Glyxambi, QTERN GASTROINTESTINAL/HEARTBURN OmePPI omeprazole INFECTIONS Mycobutin rifabutin MULTIPLE SCLEROSIS Copaxone Aubagio, Avonex, Betaseron, Extavia, Gilenya, glatiramer, Glatopa, Plegridy, Rebif, Tecfidera SEIZURE DISORDERS Lyrica CR duloxetine, gabapentin, lidocaine 5% topical patch, Lyrica SKIN CONDITIONS diclofenac 3% gel, Solaraze Fluoroplex, fluorouracil, imiquimod, Picato May 15, 2018 EYE CONDITIONS Vyzulta bimatoprost, latanoprost, Travatan Z April 1, 2018 PAIN RELIEF AND INFLAMMATORY DISEASE Duzallo allopurinol, probenecid, Uloric March 1, 2018 DIABETES Fiasp Humalog PARKINSON’S DISEASE Gocovri amantadine February 1, 2018 ASTHMA/COPD/RESPIRATORY ArmonAir QVAR, Pulmicort Flexhaler January 13, 2018 GASTROINTESTINAL/HEARTBURN Syndros dronabinol January 1, 2018 ANXIETY/DEPRESSION/BIPOLAR DISORDER Anafranil clomipramine Pamelor nortriptyline Parnate tranylcypromine Tofranil imipramine
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Generic medications start with a lowercase letter and brand name medications start with a capital letter.
909015 UPDATED_10/12/2018
The medications listed below are changing coverage (or cost levels) on Cigna’s Prescription Drug List. Changes are listed by drug list name and by the date they begin.
If you’re enrolled with Cigna, you can log into myCigna.com to find out how these changes may affect your specific plan.
STANDARD (CIGNA NATIONAL) PRESCRIPTION DRUG LIST
PRESCRIPTION DRUG LIST CHANGESCigna Pharmacy Management® 2018
Start date of change*
Drug class Medication not covered^ Generic and/or preferred brand alternatives
November 15, 2018
CANCER Yonsa ZytigaPAIN RELIEF AND INFLAMMATORY DISEASE Aimovig antiepileptic drugs, antidepressants,
January 1, 2018 ALLERGY/NASAL SPRAYS Astepro azelastine nasal spray
ATTENTION DEFICIT HYPERACTIVITY DISORDER
Adderall XR dextroamphetamine-amphetamine ER
Focalin XR dexmethylphenidate ER
SKIN CONDITIONS Ala-Scalp hydrocortisone
Analpram HC lotion hydrocortisone-pramoxine
Capex shampoo fluocinolone
Cordran flurandrenolide
Differin adapalene
Metrogel metronidazole gel
Naftin naftifine
Nucort, Texacort hydrocortisone
Start date of change*
Drug classMedication requiring prior authorization^^
Additional information
December 9, 2018
PAIN RELIEF AND INFLAMMATORY DISEASE Olumiant+ Your plan only covers this medication if your doctor requests and receives approval from Cigna. If you’re taking this medication, ask your doctor to call us soon so we can begin the review process.
August 15, 2018 ASTHMA/COPD/RESPIRATORY Lonhala
July 1, 2018 CANCER Hycamtin++, Targretin++, tretinoin capsule++, Xeloda++
MISCELLANEOUS Nityr, Orfadin++
PAIN RELIEF AND INFLAMMATORY DISEASE (NARCOTIC)
Diskets, Dolophine, methadone++, Methadose
March 1, 2018 GASTROINTESTINAL/HEARTBURN Symproic
January 1, 2018 GASTROINTESTINAL/HEARTBURN Akynzeo, Anzemet, Emend, Sancuso, Varubi
August 15, 2018 ASTHMA/COPD/RESPIRATORY Symdeko Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
acetaminophen-caffeine-dihyrocodeine, acetaminophen-codeine, Arymo, asa-butalb-caff-codeine, aspirin-caff-dihydrocodeine, belladonna-opium, buprenorphine, butalb-acetaminoph-caff-codeine, butorphanol, carisoprodol-asa-codeine, codeine sulfate, Embeda, Exalgo, Fentanyl (all dosage forms), Flowtuss, Hycofenix, hydrocodone-acetaminophen, hydrocodone-ibuprofen, Hydromet, hydromorphone, Hysingla ER, Kadian, Lorcet, Lortab, meperidine, Morphabond ER, morphine, morphine ER, nalbuphine, Nucynta, Nucynta ER, Obredon, Opana ER, opium tincture, Oxecta, oxycodone, oxycodone ER, oxycodone-acetaminophen, oxycodone-aspirin, oxycodone-ibuprofen, OxyContin, oxymorphone, oxymorphone ER, pentazocine-acetaminophen, pentazocine-naloxone, Primlev, promethazine-codeine, Talwin, tramadol ER, tramadol-acetaminophen, Trezix, Tussigon, Tussionex, Xtampza ER, Zohydro ER, Zutripro
To promote safer opioid use, your plan may limit the amount, or day supply, of narcotic pain medications (opioids) it will cover. If you’re taking an opioid, you may need approval for your prescription to be covered.
Generic medications start with a lowercase letter and brand name medications start with a capital letter.
STANDARD (CIGNA NATIONAL) PRESCRIPTION DRUG LIST (cont)
Start date of change*
Drug classMedication with quantity limits^^
Additional information
July 1, 2018 SEIZURE DISORDERS Banzel# Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
Generic medications start with a lowercase letter and brand name medications start with a capital letter.
LEGACY (PERFORMANCE) PRESCRIPTION DRUG LIST (cont)
Start date of change*
Drug classMedication requiring prior authorization^^
Additional information
December 9, 2018
PAIN RELIEF AND INFLAMMATORY DISEASE Olumiant+ Your plan only covers this medication if your doctor requests and receives approval from Cigna. If you’re taking this medication, ask your doctor to call us soon so we can begin the review process.
December 1, 2018
BLOOD MODIFIERS/BLEEDING DISORDERS Retacrit+
November 15, 2018
CANCER YonsaPAIN RELIEF AND INFLAMMATORY DISEASE Aimovig
August 15, 2018 ASTHMA/COPD/RESPIRATORY Lonhala Your plan only covers this medication if your doctor requests and receives approval from Cigna. If you’re taking this medication, ask your doctor to call us soon so we can begin the review process.
July 1, 2018 CANCER Hycamtin++, Targretin++, tretinoin capsule++, Xeloda++
MISCELLANEOUS Nityr, Orfadin++
MULTIPLE SCLEROSIS CopaxonePAIN RELIEF AND INFLAMMATORY DISEASE (NARCOTIC)
August 15, 2018 ASTHMA/COPD/RESPIRATORY Symdeko Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
July 1, 2018 ANXIETY/DEPRESSION/BIPOLAR DISORDER Aplenzin#, bupropion ER#, Celexa#,
Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
NUTRITIONAL/DIETARY Auryxia
PAIN RELIEF AND INFLAMMATORY DISEASE (NON-NARCOTIC)
acetaminophen-caffeine-dihyrocodeine, acetaminophen-codeine, Arymo, asa-butalb-caff-codeine, aspirin-caff-dihydrocodeine, belladonna-opium, buprenorphine, butalb-acetaminoph-caff-codeine, butorphanol, carisoprodol-asa-codeine, codeine sulfate, Embeda, Exalgo, Fentanyl (all dosage forms), Flowtuss, Hycofenix, hydrocodone-acetaminophen, hydrocodone-ibuprofen, Hydromet, hydromorphone, Hysingla ER, Kadian, Lorcet, Lortab, meperidine, Morphabond ER, morphine, morphine ER, nalbuphine, Nucynta, Nucynta ER, Obredon, Opana ER, opium tincture, Oxecta, oxycodone, oxycodone ER, oxycodone-acetaminophen, oxycodone-aspirin, oxycodone-ibuprofen, OxyContin, oxymorphone, oxymorphone ER, pentazocine-acetaminophen, pentazocine-naloxone, Primlev, promethazine-codeine, Talwin, tramadol ER, tramadol-acetaminophen, Trezix, Tussigon, Tussionex, Xtampza ER, Zohydro ER, Zutripro
To promote safer opioid use, your plan may limit the amount, or day supply, of narcotic pain medications (opioids) it will cover. If you’re taking an opioid, you may need approval for your prescription to be covered.
SCHIZOPHRENIA/ANTI-PSYCHOTICS Invega Sustenna# Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
January 1, 2018 INFECTIONS Zovirax Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
Generic medications start with a lowercase letter and brand name medications start with a capital letter.
LEGACY (STANDARD) PRESCRIPTION DRUG LIST (cont)
Start date of change*
Drug classMedication requiring prior authorization^^
Additional information
December 9, 2018
PAIN RELIEF AND INFLAMMATORY DISEASE Olumiant+ Actemra, Enbrel, Humira, Remicade
November 15, 2018
CANCER Yonsa Your plan only covers this medication if your doctor requests and receives approval from Cigna. If you’re taking this medication, ask your doctor to call us soon so we can begin the review process.
August 15, 2018 ASTHMA/COPD/RESPIRATORY Lonhala Your plan only covers this medication if your doctor requests and receives approval from Cigna. If you’re taking this medication, ask your doctor to call us soon so we can begin the review process.
July 1, 2018 CANCER Hycamtin++, Targretin++, tretinoin capsule++, Xeloda++
MISCELLANEOUS Nityr, Orfadin++
MULTIPLE SCLEROSIS CopaxonePAIN RELIEF AND INFLAMMATORY DISEASE (NARCOTIC)
Diskets, Dolophine, methadone++, Methadose
April 1, 2018 PAIN RELIEF AND INFLAMMATORY DISEASE Duzallo
March 1, 2018 GASTROINTESTINAL/HEARTBURN Symproic
January 13, 2018 GASTROINTESTINAL/HEARTBURN Syndros
August 15, 2018 ASTHMA/COPD/RESPIRATORY Symdeko Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
NUTRITIONAL/DIETARY Auryxia
PAIN RELIEF AND INFLAMMATORY DISEASE (NON-NARCOTIC)
acetaminophen-caffeine-dihyrocodeine, acetaminophen-codeine, Arymo, asa-butalb-caff-codeine, aspirin-caff-dihydrocodeine, belladonna-opium, buprenorphine, butalb-acetaminoph-caff-codeine, butorphanol, carisoprodol-asa-codeine, codeine sulfate, Embeda, Exalgo, Fentanyl (all dosage forms), Flowtuss, Hycofenix, hydrocodone-acetaminophen, hydrocodone-ibuprofen, Hydromet, hydromorphone, Hysingla ER, Kadian, Lorcet, Lortab, meperidine, Morphabond ER, morphine, morphine ER, nalbuphine, Nucynta, Nucynta ER, Obredon, Opana ER, opium tincture, Oxecta, oxycodone, oxycodone ER, oxycodone-acetaminophen, oxycodone-aspirin, oxycodone-ibuprofen, OxyContin, oxymorphone, oxymorphone ER, pentazocine-acetaminophen, pentazocine-naloxone, Primlev, promethazine-codeine, Talwin, tramadol ER, tramadol-acetaminophen, Trezix, Tussigon, Tussionex, Xtampza ER, Zohydro ER, Zutripro
To promote safer opioid use, your plan may limit the amount, or day supply, of narcotic pain medications (opioids) it will cover. If you’re taking an opioid, you may need approval for your prescription to be covered.
SEIZURE DISORDERS Banzel# Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
Generic medications start with a lowercase letter and brand name medications start with a capital letter.
LEGACY (STANDARD) PRESCRIPTION DRUG LIST (cont)
Start date of change*
Drug classMedication with quantity limits^^
Additional information
January 1, 2018 INFECTIONS Zovirax Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
Drug classMedication requiring prior authorization^^
Additional information
December 9, 2018
PAIN RELIEF AND INFLAMMATORY DISEASE Olumiant+ Your plan only covers this medication if your doctor requests and receives approval from Cigna. If you’re taking this medication, ask your doctor to call us soon so we can begin the review process.
August 15, 2018 ASTHMA/COPD/RESPIRATORY Lonhala
July 1, 2018 CANCER Hycamtin++, Targretin++, tretinoin capsule++, Xeloda++
August 15, 2018 ASTHMA/COPD/RESPIRATORY Symdeko Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
acetaminophen-caffeine-dihyrocodeine, acetaminophen-codeine, Arymo, asa-butalb-caff-codeine, aspirin-caff-dihydrocodeine, belladonna-opium, buprenorphine, butalb-acetaminoph-caff-codeine, butorphanol, carisoprodol-asa-codeine, codeine sulfate, Embeda, Exalgo, Fentanyl (all dosage forms), Flowtuss, Hycofenix, hydrocodone-acetaminophen, hydrocodone-ibuprofen, Hydromet, hydromorphone, Hysingla ER, Kadian, Lorcet, Lortab, meperidine, Morphabond ER, morphine, morphine ER, nalbuphine, Nucynta, Nucynta ER, Obredon, Opana ER, opium tincture, Oxecta, oxycodone, oxycodone ER, oxycodone-acetaminophen, oxycodone-aspirin, oxycodone-ibuprofen, OxyContin, oxymorphone, oxymorphone ER, pentazocine-acetaminophen, pentazocine-naloxone, Primlev, promethazine-codeine, Talwin, tramadol ER, tramadol-acetaminophen, Trezix, Tussigon, Tussionex, Xtampza ER, Zohydro ER, Zutripro
To promote safer opioid use, your plan may limit the amount, or day supply, of narcotic pain medications (opioids) it will cover. If you’re taking an opioid, you may need approval for your prescription to be covered.
PERFORMANCE PRESCRIPTION DRUG LIST (cont)
Generic medications start with a lowercase letter and brand name medications start with a capital letter.
Start date of change*
Drug classMedication with quantity limits^^
Additional information
July 1, 2018 SCHIZOPHRENIA/ANTI-PSYCHOTICS Invega Sustenna# Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
Drug classMedication requiring prior authorization^^
Additional information
December 9, 2018
PAIN RELIEF AND INFLAMMATORY DISEASE Olumiant+ Actemra, Enbrel, Humira, Remicade
August 15, 2018 ASTHMA/COPD/RESPIRATORY Lonhala Your plan only covers this medication if your doctor requests and receives approval from Cigna. If you’re taking this medication, ask your doctor to call us soon so we can begin the review process.
July 1, 2018 CANCER Hycamtin++, Targretin++, tretinoin capsule++, Xeloda++
August 15, 2018 ASTHMA/COPD/RESPIRATORY Symdeko Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
NUTRITIONAL/DIETARY Auryxia Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
PAIN RELIEF AND INFLAMMATORY DISEASE (NON-NARCOTIC)
Cafergot, ergotamine-caffeine
diclofenac 1% gel, Voltaren
PAIN RELIEF AND INFLAMMATORY DISEASE (NARCOTIC)
acetaminophen-caffeine-dihyrocodeine, acetaminophen-codeine, Arymo, asa-butalb-caff-codeine, aspirin-caff-dihydrocodeine, belladonna-opium, buprenorphine, butalb-acetaminoph-caff-codeine, butorphanol, carisoprodol-asa-codeine, codeine sulfate, Embeda, Exalgo, Fentanyl (all dosage forms), Flowtuss, Hycofenix, hydrocodone-acetaminophen, hydrocodone-ibuprofen, Hydromet, hydromorphone, Hysingla ER, Kadian, Lorcet, Lortab, meperidine, Morphabond ER, morphine, morphine ER, nalbuphine, Nucynta, Nucynta ER, Obredon, Opana ER, opium tincture, Oxecta, oxycodone, oxycodone ER, oxycodone-acetaminophen, oxycodone-aspirin, oxycodone-ibuprofen, OxyContin, oxymorphone, oxymorphone ER, pentazocine-acetaminophen, pentazocine-naloxone, Primlev, promethazine-codeine, Talwin, tramadol ER, tramadol-acetaminophen, Trezix, Tussigon, Tussionex, Xtampza ER, Zohydro ER, Zutripro
To promote safer opioid use, your plan may limit the amount, or day supply, of narcotic pain medications (opioids) it will cover. If you’re taking an opioid, you may need approval for your prescription to be covered.
VALUE PRESCRIPTION DRUG LIST (cont)
Generic medications start with a lowercase letter and brand name medications start with a capital letter.
Start date of change*
Drug classMedication with quantity limits^^
Additional information
July 1, 2018 SEIZURE DISORDERS Banzel# Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
SKIN CONDITIONS calcitriol
SLEEP DISORDERS/SEDATIVES Rozerem
February 1, 2018 BLOOD THINNERS/ANTI-CLOTTING Bevyxxa
January 1, 2018 ALLERGY/NASAL SPRAYS cromolyn oral, mometasone
ALZHEIMER'S DISEASE Namenda XR, Namzaric
ANXIETY/DEPRESSION/BIPOLAR DISORDER desvenlafaxine ER, Marplan
Talk with your doctor to find out if there are lower-cost options available.
PARKINSON'S DISEASE Azilect rasagiline
SEIZURE DISORDERS Lamictal ODT lamotrigine ODT
SKIN CONDITIONS Ameluz+, Levulan+ Talk with your doctor to find out if there are lower-cost options available.
SLEEP DISORDERS/SEDATIVES Hetlioz+ Talk with your doctor to find out if there are lower-cost options available.
TRANSPLANT MEDICATIONS Cellcept+ mycophenolate
URINARY TRACT CONDITIONS Thiola+ Talk with your doctor to find out if there are lower-cost options available.
March 1, 2018 GASTROINTESTINAL/HEARTBURN Symproic Talk with your doctor to find out if there are lower-cost options available.
February 1, 2018 BLOOD THINNERS/ANTI-CLOTTING Bevyxxa enoxaparin
January 1, 2018 ATTENTION DEFICIT HYPERACTIVITY DISORDER Adderall XR dextroamphetamine-amphetamine ER
Start date of change*
Drug classMedication requiring prior authorization^^
Additional information
December 9, 2018
PAIN RELIEF AND INFLAMMATORY DISEASE Olumiant+ Your plan only covers this medication if your doctor requests and receives approval from Cigna. If you’re taking this medication, ask your doctor to call us soon so we can begin the review process.
July 1, 2018 CANCER Hycamtin++, Targretin++, tretinoin capsule++, Xeloda++
MISCELLANEOUS Nityr, Orfadin++
PAIN RELIEF AND INFLAMMATORY DISEASE (NARCOTIC)
Diskets, Dolophine, methadone++, Methadose
March 1, 2018 GASTROINTESTINAL/HEARTBURN Symproic
ADVANTAGE PRESCRIPTION DRUG LIST (cont)
Generic medications start with a lowercase letter and brand name medications start with a capital letter.
Start date of change*
Drug classMedication requiring prior authorization^^
Additional information
January 1, 2018 GASTROINTESTINAL/HEARTBURN Akynzeo, Anzemet, Emend, Sancuso, Varubi
Your plan only covers this medication if your doctor requests and receives approval from Cigna. If you’re taking this medication, ask your doctor to call us soon so we can begin the review process.
August 15, 2018 ASTHMA/COPD/RESPIRATORY Symdeko Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
acetaminophen-caffeine-dihyrocodeine, acetaminophen-codeine, Arymo, asa-butalb-caff-codeine, aspirin-caff-dihydrocodeine, belladonna-opium, buprenorphine, butalb-acetaminoph-caff-codeine, butorphanol, carisoprodol-asa-codeine, codeine sulfate, Embeda, Exalgo, Fentanyl (all dosage forms), Flowtuss, Hycofenix, hydrocodone-acetaminophen, hydrocodone-ibuprofen, Hydromet, hydromorphone, Hysingla ER, Kadian, Lorcet, Lortab, meperidine, Morphabond ER, morphine, morphine ER, nalbuphine, Nucynta, Nucynta ER, Obredon, Opana ER, opium tincture, Oxecta, oxycodone, oxycodone ER, oxycodone-acetaminophen, oxycodone-aspirin, oxycodone-ibuprofen, OxyContin, oxymorphone, oxymorphone ER, pentazocine-acetaminophen, pentazocine-
To promote safer opioid use, your plan may limit the amount, or day supply, of narcotic pain medications (opioids) it will cover. If you’re taking an opioid, you may need approval for your prescription to be covered.
ADVANTAGE PRESCRIPTION DRUG LIST (cont)
Generic medications start with a lowercase letter and brand name medications start with a capital letter.
Start date of change*
Drug classMedication with quantity limits^^
Additional information
July 1, 2018 PAIN RELIEF AND INFLAMMATORY DISEASE (NARCOTIC) (cont)
naloxone, Primlev, promethazine-codeine, Talwin, tramadol ER, tramadol-acetaminophen, Trezix, Tussigon, Tussionex, Xtampza ER, Zohydro ER, Zutripro
To promote safer opioid use, your plan may limit the amount, or day supply, of narcotic pain medications (opioids) it will cover. If you’re taking an opioid, you may need approval for your prescription to be covered.
SCHIZOPHRENIA/ANTI-PSYCHOTICS Invega Sustenna# Your plan only covers up to a certain amount of this medication over a certain amount of time. If you’re taking this medication, you may need approval for your prescription to be covered.
SEIZURE DISORDERS Banzel#
SKIN CONDITIONS calcitriol
SLEEP DISORDERS/SEDATIVES Rozerem
February 1, 2018 BLOOD THINNERS/ANTI-CLOTTING Bevyxxa
January 1, 2018 ALLERGY/NASAL SPRAYS cromolyn oral, mometasone
ALZHEIMER'S DISEASE Namenda XR, Namzaric
ANXIETY/DEPRESSION/BIPOLAR DISORDER desvenlafaxine ER, Marplan
Medication strength with limitations** (Your plan doesn’t cover 2 capsules/tablets per day of this strength)
Covered medication strength(Prescription must be for 1 capsule/tablet per day of this strength)
January 1, 2018 ANXIETY/DEPRESSION/BIPOLAR DISORDER Fetzima ER 20mg Fetzima ER 40mg Fetzima ER 40mg Fetzima ER 80mg Trintellix 5mg Trintellix 10mg Trintellix 10mg Trintellix 20mg
Generic medications start with a lowercase letter and brand name medications start with a capital letter.
* State laws in Texas and Louisiana require health insurance plans to cover your medications at your current benefit level until your plan renews. This means that if your medication is taken off the drug list, is moved to a higher cost-share tier or needs approval, your plan can’t make these changes until your renewal date. To find out if these state laws apply to your plan, please call Customer Service using the number on the back of your ID card.
+ This is a specialty medication. Some plans cover these medications on a specialty tier, may limit you to a 30-day supply and/or require you to use Cigna Specialty Pharmacy (our home delivery pharmacy) to fill your prescription. For plans that cover specialty medications on a specialty tier, this change will not affect the cost of the medication. If you’re enrolled with Cigna, log in to the myCigna website or app or check your plan materials to learn more about your plan’s coverage requirements for specialty medications.
++ Approval may be required for new prescriptions filled on or after July 1st.^ These medications require approval from Cigna before they may be covered by your plan. If your doctor feels an alternative medication isn’t right for you, he or she can ask Cigna to consider
approving coverage of your medication.^^ These changes may not apply to your plan. Not all plans include requirements for prior authorization, quantity limits and/or Step Therapy. If you’re enrolled with Cigna, please check your plan
materials or log in to the myCigna website or app starting July 1st to learn more about how your plan covers these medications.# Quantity limits may apply to new prescriptions filled on or after July 1st.
## This is a Step Therapy medication. Step Therapy medications aren’t covered by your plan without approval from Cigna. Your plan requires you to try a lower-cost alternative first. Typically, these are generics or lower-cost preferred brands.
** Your plan doesn’t cover more than one tablet/capsule in this strength a day. If your doctor feels a higher strength of this medication once each day isn’t right for you, he or she can ask Cigna to consider approving coverage of your current medication strength.
Cigna reserves the right to make changes to the Drug List without notice.
Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. If your plan provides coverage for certain prescription drugs with no cost-share, you may be required to use an in-network pharmacy to fill the prescription. If you use a pharmacy that does not participate in your plan’s network, your prescription may not be covered, or reimbursement may be limited by your plan’s copayment, coinsurance or deductible requirements. Certain features described in this document may not be applicable to your specific health plan, and plan features may vary by location and plan type. Refer to your plan documents for costs and complete details of your plan’s prescription drug coverage.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Health Management, Inc., Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of Cigna Health Corporation, including Cigna HealthCare of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc., Cigna HealthCare of Florida, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Indiana, Inc., Cigna HealthCare of St. Louis, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of New Jersey, Inc., Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of Tennessee, Inc., and Cigna HealthCare of Texas, Inc. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.