Frequently Asked Questions (FAQs) Understanding your prescription medication coverage can be confusing. Here are answers to some commonly asked questions.
Q. Why do you make changes to the drug list? A. We regularly review and update your plan’s drug list to make sure you’re getting coverage for low-cost, safe, clinically effective medications. We make changes for many reasons – like when new medications become available or are no longer available, or when medication prices change. These changes may include: • Moving a medication to a lower cost tier. This can happen at any time during the year. • Moving a brand medication to a higher cost tier when a generic becomes available. This can happen at any time during the year. • Moving a medication to a higher cost tier and/or no longer covering a medication. This typically happens twice a year on January 1 st and July 1 st . • Adding extra coverage requirements to a medication. When we make a change that affects the coverage of a medication you’re taking, we let you know before it happens. This way, you have time to talk with your doctor about your options. Only you and your doctor can decide what’s best for your treatment. Q. Why doesn’t my plan cover certain medications? A. To help lower your overall health care costs, your plan doesn’t cover certain high-cost brand-name medications that have lower-cost alternatives. That’s because these lower-cost options work the same as, or similar to, the non-covered medication. If you’re taking a medication that isn’t covered and your doctor feels a different medication isn’t right for you, he or she can ask Cigna Healthcare to consider approving your medication through the coverage review process. There are also certain medications and products that can't be covered by your plan for any reason because they’re considered to be a “plan or benefit exclusion.” This means the medication or product isn’t on your plan’s drug list, and there’s no option to ask Cigna Healthcare to consider approving it through
the coverage review process. For example, your plan doesn’t cover, or “excludes,” medications that aren’t approved by the U.S. Food and Drug Administration (FDA). Q. How do you decide which medications to cover? A. The Cigna Healthcare Prescription Drug List is developed with the help of the Cigna Healthcare Pharmacy and Therapeutics (P&T) Committee, which is a group of practicing doctors and pharmacists, most of whom work outside of Cigna Healthcare. The group meets regularly to review medical evidence and information provided by federal agencies, drug manufacturers, medical professional associations, national organizations and peer-reviewed journals about the safety and effectiveness of medications that are newly approved by the FDA and medications already on the market. The Cigna Healthcare Health Plan Commercial Value Assessment Committee (HVAC) then looks at the results of the P&T Committee’s clinical review, as well as the medication’s overall value and other factors before adding it to, or removing it from, the drug list. Q. Why do certain medications need approval before my plan will cover them? A. The review process helps to make sure you’re receiving coverage for the right medication, at the right cost, in the right amount and for the right situation. Q. How do I know if I’m taking a medication that needs approval? A. Log in to the myCigna App or myCigna.com , or check your plan materials, to learn more about how your plan covers your medications. If your medication has a (PA) or (ST) next to it, your medication needs approval before your plan will cover it. If it has a (QL) next to it, you may need approval depending on the amount you’re filling. If it has (AGE) next to it, you may need approval depending on the covered age range for the medication.
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