Cigna Healthcare Standard 4-Tier Prescription Drug List Specialty medications are covered on Tier 4 (listed on pages 17-20).
TIER 1 $
TIER 2 $$
TIER 3 $$$
TIER 1 $
TIER 2 $$
TIER 3 $$$
VACCINES (cont.) Not all plans cover vaccines in the same way. Log in to the myCigna App or myCigna.com , or check your plan materials, to find out how your specific plan covers them. PEDIARIX+
WEIGHT MANAGEMENT
LOMAIRA^ megestrol
WEGOVY^ (PA, QL) ZEPBOUND^ (PA, QL)
ADIPEX-P^ (PA) CONTRAVE^ (PA) QSYMIA^ (PA) SAXENDA^ (PA)
PEDVAXHIB+ PENBRAYA+ PENTACEL ACTHIB COMPONENT+ PENTACEL+ PFIZER COVID VAC(EUA)+ PFIZER COVID-19 VACCINE (EUA)+ PNEUMOVAX 23+ PREHEVBRIO+ PREVNAR 20 PRIORIX+ PROQUAD+ QUADRACEL DTAP- IPV+ RECOMBIVAX HB+ SHINGRIX+ (QL) SPIKEVAX+ SPIKEVAX COVID (18Y UP) VACC+ TDVAX+ TENIVAC+ TRUMENBA+ TWINRIX+ VARIVAX VACCINE+ VAXELIS+ VAXNEUVANCE+ QUADRACEL DTAP- IPV+ RECOMBIVAX HB+ SHINGRIX+ (QL) SPIKEVAX COVID (18Y UP) VACCINE+ TDVAX+ TENIVAC+ TRUMENBA+ TWINRIX+ VARIVAX VACCINE+ VAXELIS+ VAXNEUVANCE+
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