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 January 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 the Cigna Healthcare Standard 4-Tier Prescription Drug List.
Medications are grouped by the condition they treat; Specialty medications are listed on Tier 4 (pages 19–27) Tier (cost-share level) gives you an idea of how much you may pay for a medication
TIER 1 $
TIER 2 $$
TIER 3 $$$
HORMONAL AGENTS ANDRODERM (PA, QL) ANDROGEL 1.62% (PA, QL) ARMOUR THYROID CYTOMEL 50mcg
AMABELZ budesonide EC cabergoline (QL) COVARYX COVARYX H.S. DECADRON desmopressin dexamethasone estradiol- norethindrone estrogen- methyltestosterone levothyroxine LEVOXYL liothyronine medroxy-progesterone methimazole methylprednisolone MIMVEY MIMVEY LO NATURE-THROID NP THYROID prednisolone prednisolone ODT prednisone prednisone intensol progesterone
ACTIVELLA ALORA (QL) ANDROGEL 1.0% (PA, QL) ANGELIQ CLIMARA CLIMARA PRO Combipatch CYTOMEL 5, 25mcg DEPO-TESTOSTERONE ELESTRIN ENTOCORT EC ESTRACE ESTROGEL
DIVIGEL DUAVEE ESTRING (QL) PREMARIN PREMPHASE PREMPRO
Medications are listed in alphabetical order within each column
EVAMIST FEMRING INTRAROSA LEVO-T
Medications that have extra coverage requirements have an abbreviation listed next to them
MENOSTAR (QL) MINIVELLE (QL) OSPHENA TIROSINT UNITHROID VAGIFEM (QL) VIVELLE-DOT (QL)
Brand-name medications are in all capital letters
Generic medications are in all lowercase letters
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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