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Three-Tier Plan
2010 CIGNA
Choosing the medication that is right for you should be up to you and your doctor. So, we offer you an extensive list of brand and generic medications to choose the “right” one based on how well it works and how much it costs.
Choosing where to fill your medication should be easy, too. With over 57,000 pharmacies network, you will have convenient access to your medications – whether you pick them up, or have them delivered to your home.
Enclosed you will find a list of covered medication choices in an easy-to-read format. Drug Plan
A three-tier prescription drug plan splits medications
into three categories or tiers:
1st Tier – Generic medications: Generic medications
have the same active ingredients, safety, dosage, quality and strength as their brand-name counterparts. You will typically pay less for generic medications under a three-tier plan.
2nd Tier – Preferred Brand medications: Preferred Brand
medications will typically cost you more than generic, but may cost you less than a Non-Preferred 3rd Tier – Non-Preferred Brand medications: Non-
Preferred Brand medications are those that generally have generic alternatives and/or one or more Preferred Brand medication options within the same class of medication. You will typically pay more for Non-Preferred Brand medications on a The Right Tools To Help You
myciGNA.com
When you go to the “Pharmacy” tab of Look up your specific pharmacy coverage; Research thousands of medications available; Find out the actual amount you will pay for Ask a pharmacist questions; Download forms; and more.
Home CIGNA Home Delivery Pharmacy is especially for individuals who take prescription medications on a regular basis (including Specialty medications). Up to a three-month supply of medications in Delivery of your medication to your home at “Pharmacy” tab on myCIGNA.com or call 1.800.835.3784, and we will be happy to help you. To order a specialty medication, visit www.cigna.com and click “Resources for Members.” You will see the “Specialty Pharmacy” tab where the specialty medication order form is located. You can also call 1.800.351.3606 to speak OptionPreventive medications are those prescribed to prevent the occurrence of a disease or condition for those with risk factors, such as high blood pressure, high cholesterol, diabetes, asthma, osteoporosis, heart attack and stroke, or to prevent the recurrence of the disease or condition for those individuals who have recovered. Preventive medications do not include medications used to treat an existing illness, For some pharmacy plans that require you to pay a certain amount toward your medications before the plan coverage begins, preventive medications may be covered before you reach that amount. However, to be sure, you should read your enrollment information to see how preventive medications are covered based on your specific plan. A list of all covered preventive medications is also available on www.cigna.com. Preventive medications are identified by a “PM” symbol Prescription Drug List Every medication available on CIGNA’s prescription drug list has been approved by the U.S. Food and Drug Administration (FDA). This list represents the most commonly prescribed medications. If you do not see a specific medication on this list, please check www.cigna.com, go to the “Resources for Members” tab, and click “Drug Lists” for the most up-to-date list of medications.
Refer to your enrollment information to find which specific medications are covered under your plan. The symbols on the list mean . . .
If your medication has one of the following authorization for coverage of that medication. Please read to understand what they mean:
PA: Prior Authorization may be required for different
reasons. To learn the requirement for a specific medication, give us a call and we will explain it.
QL: Quantity Limit means you may have coverage
for a limited amount of a specific medication.
AGE: Age Requirement means an individual must
be within a specific age group for a specific medication to be covered.
ST: Step Therapy is a prior authorization program
that may require you try other medications available to treat the same condition before the If You Have QuestionsWe’re here to help. Just call us at the toll-free number on your CIGNA ID card, and we will be happy to help answer your questions.
ADD/ADHD
AIDS/HIV
ALZHEIMER
BIRTH CONTROL*
* Please check your enrollment materials to determine whether these medications are covered under your specific plan. BLADDER PROBLEMS
CARDIOVASCULAR
CARDIOVASCULAR (CONTINUED)
CHOLESTEROL LOWERING
DEPRESSION
DIABETES
EYE CONDITIONS
GROWTH HORMONES
HEARTBURN/ULCER
HORMONE REPLACEMENT
HORMONE REPLACEMENT (CONTINUED)
INFECTIONS
MIGRAINE
MULTIPLE SCLEROSIS
NAUSEA AND VOMITING
OSTEOPOROSIS
PAIN RELIEF & INFLAMMATORY DISEASE
PARKINSON’S DISEASE
PROSTATE
MULTIPLE SCLEROSIS
SCHIZOPHRENIA
SKIN CONDITIONS
MISCELLANEOUS
ExCLUSIONS & LIMITATIONS
Plans typically do not provide coverage for the following, except as required by law or 1. Any medications available over-the-counter that do not require a prescription by Federal or State Law, and any medication that is a pharmaceutical alternative to an over-the-counter medication other than insulin. 2. Medications that are therapeutically equivalent as determined by the CIGNA HealthCare Pharmacy and Therapeutics Commit ee in which at least one of the medications within the class is available over-the-counter.
3. Any injectable infertility medications, and any injectable medications that require Health Care Professional supervision and are not typically considered self-administered medications. The following are examples of Health Care Professional supervised medications: Injectables used to treat hemophilia and RSV (respiratory syncytial virus), chemotherapy injectables, and endocrine and 4. Any medications that are experimental or investigational, within the meaning set forth in the summary plan description. 5. Food and Drug Administration (FDA) approved medications used for purposes other than those approved by the FDA unless the medication is recognized for the treatment of the particular indication in one of the standard reference compendia (The United States Pharmacopoeia Drug Information or The American Hospital Formulary Service Drug Information) or in medical literature. Medical literature means scientific studies published in a peer-reviewed national 6. Any prescription and non-prescription supplies (such as ostomy supplies), 7. Any contraceptive medications and prescription appliances for contraception. 8. Implantable contraceptive products. 9. Any fertility medication. 10. Any medications used for treatment of sexual dysfunction, including but not limited to erectile dysfunction, delayed ejaculation, anorgasmia and decreased 11. Any prescription vitamins (other than prenatal vitamins), dietary supplements 12. Medications used for cosmetic purposes, such as medications used to reduce wrinkles, medications to promote hair growth, medications used to control 13. Any diet pills or appetite suppressants (anorectics). 14. Prescription smoking cessation products. 15. Immunization agents, biological products for al ergy immunization, biological sera, blood, blood plasma and other blood products or fractions and medications 16. Replacement of prescription medications and related supplies due to loss or 17. Medications used to enhance athletic performance. 18. Medications which are to be taken by or administered to a Customer while the Customer is a patient in a licensed hospital, skilled nursing facility, rest home or similar institution which operates on its premises or allows to be operated on its premises a facility for dispensing pharmaceuticals. 19. Prescriptions more than one year from the original date of issue.
changes to this Drug List without notice. Your plan may cover additional medications; please refer to your enrollment materials for details. CIGNA does not take responsibility for any medication decisions made by the prescriber or pharmacist. CIGNA may receive payments from manufacturers of certain Preferred Brand medications, and in limited instances, certain Non-Preferred Brand medications, which may or may not be shared with your plan depending on its arrangement with CIGNA. Depending upon plan design, market conditions, the extent to which manufacturer payments are shared with your plan, and other factors as of the date of service, the Preferred Brand medication may or may not represent the lowest cost brand medication within its class for you and/or your plan. “CIGNA,” “CIGNA HealthCare” and the “Tree of Life” logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by CIGNA Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc. and its affiliates, CIGNA Behavioral Health, Inc., Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. In Arizona, HMO plans are offered by CIGNA HealthCare of Arizona, Inc. In California, HMO plans are offered by CIGNA HealthCare of California, Inc. and Great-West Healthcare of California, Inc. In Connecticut, HMO plans are offered by CIGNA HealthCare of Connecticut, Inc. In Virginia, HMO plans are offered by CIGNA HealthCare Mid- Atlantic, Inc. In North Carolina, HMO plans are offered by CIGNA HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by Connecticut

Source: http://www.dataworkforce.com/docs/contractors/cigna_medical/Cigna_2010_3_tier_pharmacy.pdf