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 • Tier 2 – Typically Preferred Brands • Tier 3 – Typically Non-Preferred Brands • Tier 4 – Injectable Specialty Medications*
(Lowest-cost medication) (Medium-cost medication) (Higher-cost medication) (Highest-cost medication)
$
$$
$$$
$$$$
* Oral specialty medications are covered on a lower tier (tiers 1-3).
Abbreviations next to medications In this drug list, medications that have limits and/or extra coverage requirements have an abbreviation listed next to them.* Here’s what they mean.
(PA)
P rior Authorization – Certain medications need approval from Cigna Healthcare before your plan will cover them. These medications have a (PA) next to them. Your plan won’t cover these medications unless your doctor requests, and receives, approval from Cigna Healthcare. Quantity Limits – Some medications have a quantity limit. This means your plan will only cover up to a certain amount over a certain length of time. These medications have a (QL) next to them. Your plan will only cover a larger amount if your doctor requests, and receives, approval from Cigna Healthcare. Step Therapy – Certain high-cost medications aren’t covered until you try one or more lower-cost alternatives first.** These medications have a (ST) next to them. You have many covered options to choose from, and they’re used to treat the same condition. Age Requirements – Certain medications will only be covered if you’re within a specific age range. These medications have (AGE) next to them. If you’re not within the allowed age range, your plan will only cover the medication if your doctor requests, and receives, approval from Cigna Healthcare .
(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. ** If your doctor feels an alternative isn’t right for you, he or she can ask Cigna Healthcare to consider approving coverage of your medication.
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. Oral specialty medications have an asterisk next to them 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, injectable specialty medications are covered on Tier 4 (see pages 19-27). Oral specialty medications are covered on a lower tier (tiers 1-3). They're listed alphabetically by the condition they treat, and have an asterisk (*) next to them.
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