About this drug list This is a list of the most commonly prescribed medications covered on the Cigna Healthcare Standard 4-Tier Prescription Drug List as of July 1, 2024. Medications are listed by the condition they treat, then listed alphabetically within tiers (or cost-share levels). The drug list is updated often so it isn’t a full list of the medications your plan covers. Also, your specific plan may not cover all of these medications. Log in to the myCigna App or myCigna.com , or check your plan materials, to see all of the medications your plan covers. How to read this drug list Use the chart below to help you read this drug list. This chart is just an example. It may not show how these medications are actually covered on this drug list.
Tier (cost-share level) gives you an idea of how much you may pay for a medication
TIER 1 $
TIER 2 $$
TIER 3 $$$
Medications are grouped by the condition they treat; Specialty medications are covered on Tier 4 (pages 17-20)
HORMONAL AGENTS ANDRODERM (PA, QL) COMBIPATCH DUAVEE ESTRING (QL) ESTROGEL MEDROL 2 MG TABLET MYFEMBREE (PA,QL)
AMABELZ budesonide dr budesonide ec budesonide er (PA, QL) cabergoline (QL) DECADRON desmopressin DEXABLISS dexamethasone (PA) dexamethasone intensol DOTTI (QL) estradiol (once weekly) estradiol 10mcg vaginal insert (QL) estradiol (twice weekly) (QL) estradiol-norethindrone acetate EUTHYROX LEVO-T LEVOXYL liothyronine LYLLANA (QL) medroxyprog- esterone methyl-prednisolone
ACTIVELLA ALORA (QL) ANDROGEL (PA, QL) ANGELIQ ARMOUR THYROID (PA) AYGESTIN BIJUVA CLIMARA (PA) CLIMARA PRO (PA) CRINONE 4% CYTOMEL DDAVP (PA) DEPO-TESTOSTERONE DIVIGEL (PA)
Medications are listed in alphabetical order within each column
ORIAHNN (PA, QL) ORILISSA (PA, QL) PREMARIN TABLET, VAGINAL CREAM
Medications that have extra coverage requirements have an next to them
APPLICATOR PREMPHASE PREMPRO
ELESTRIN (PA) ESTRACE (PA) EVAMIST FEMRING (PA) FORTESTA (PA, QL) HEMADY IMVEXXY (PA, QL) INTRAROSA (QL) JATENZO (PA, QL)
Generic medications are in all lowercase letters
Brand-name medications are in all capital letters
levothyroxine tablets MEDROL 8MG, 16MG, 32MG TABLET MEDROL 4 MG DOSEPAK MENOSTAR (QL)
millipred MIMVEY norethindrone
This chart is just a sample. It may not show how these medications are actually covered on the Cigna Healthcare Standard 4-Tier Prescription Drug List.
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