Tiers Covered medications are divided into tiers or cost-share levels. Typically, the higher the tier, the higher the price you’ll pay to fill the prescription.
• Tier 1 – Typically Generics
(Lowest-cost medication)
$
• Tier 2 – Typically Preferred Brands
(Medium-cost medication)
$$
• Tier 3 – Typically Non-Preferred Brands
(Higher-cost medication)
$$$
• Tier 4 – Specialty Medications
(Highest-cost medication)
$$$$
Letters (acronyms) next to medication names Certain medications may need approval from Cigna Healthcare before they can be covered.* This extra step helps make sure you’re getting the right coverage for the right medication. In this drug list, medications that have extra coverage requirements or limits have letters (acronyms) in parenthesis next to them. Here’s what they mean.
(PA)
P rior Authorization – This medication needs approval from Cigna Healthcare before your plan will cover it. Your doctor’s office will have to send us information to review to make sure the medication meets coverage requirements. Quantity Limit – Your plan will only cover a certain amount of this medication at one time. If your doctor wants you to fill more than what’s allowed, your doctor’s office can ask Cigna Healthcare to approve more. Step Therapy – Your plan doesn’t cover this high-cost medication until you try at least one lower-cost option first (typically a generic or preferred brand) and it didn’t work for you. If your doctor feels a different medication isn’t right for you, your doctor’s office can ask Cigna Healthcare to approve coverage of this medication. Age Requirement – Your plan will only cover this mediation if you’re a certain age or within a certain age range. If you’re not within the allowed age range and your doctor wants you to take this medication, your doctor’s office can ask Cigna Healthcare to approve coverage .
(QL)
(ST)
(AGE)
* These coverage requirements may not apply to your specific plan. Log in to the myCigna App or myCigna.com, or check your plan materials, to find out if your plan includes prior authorization, quantity limits, Step Therapy and/or age requirements.
Brand-name medications are in all capital letters In this drug list, generic medications are listed in all lowercase letters and brand-name medications are listed in all CAPITAL letters. Specialty medications are covered on Tier 4 Specialty medications are used to treat complex medical conditions. They’re typically injected or infused and may need special handling (like refrigeration). Some plans may limit coverage to a 30-day supply and/or require you to use a preferred specialty pharmacy to receive coverage. In this drug list, all specialty medications are covered on Tier 4 (see pages 17–20). Injectable specialty medications are marked with an asterisk (*) and oral specialty medications are marked with a double asterisk (**) .
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