Cigna Standard 4-Tier Prescription Drug List

Specialty medications (Cont.) Oral and injectable specialty medications are covered on Tier 4. Injectable specialty medications are marked with an asterisk (*) and oral specialty medications are marked with a double asterisk (**) .

Transplant Medications CELLCEPT CAPSULE, ORAL SUS - PENSION, TABLET** ENVARSUS XR** IMURAN** LUPKYNIS** (PA, QL) mycophenolate capsule, suspen- sion** RAPAMUNE** sirolimus** tacrolimus**

Generic medications are listed in all lowercase letters and brand-name medications are listed in all capital letters. Injectable specialty medications are marked with an asterisk (*) and oral specialty medications are marked with a double asterisk (**).

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