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Two-Tier Plan
2011 CIGNA
Choosing the medication that is right for you offer an extensive list of brand and generic Choosing where to fill your medication should be easy, too. With over 60,000 pharmacies network, you will have convenient access to your medications – whether you pick them up, or Enclosed you will find a list of medications covered by your plan, in an easy-to-read format. 1. Medications listed in categories (generic and 2. Health conditions and medications listed in 3. Symbols to let you know if there are any Drug Plan
A two-tier prescription drug plan splits
medications into two categories or tiers:
1st Tier – Generic medications: Generic medications
have the same active ingredients, safety, dosage, quality and strength as their brand-name counterparts. You will typically pay less for generic medications under a two-tier plan.
2nd Tier – Brand medications: Brand medications are
sold under a brand name given by the manufacturer. Not al brand-name medications have a generic alternative available. You wil typical y pay more for brand-name medications under a two-tier plan.
Preventive Prescription Drug OptionPreventive medications are prescribed to prevent the occurrence of a disease or condition with risk factors such as: high blood pressure, high cholesterol, diabetes, asthma, osteoporosis, heart attack and stroke, or to prevent the recurrence of the disease or condition for individuals who have recovered. Preventive medications do not include drugs used to treat an existing illness, injury or condition. For some pharmacy plans that require you to pay
a certain amount before the plan coverage begins,
preventive medications may be covered before
you reach that amount. To be sure, you should read
your enrollment information to see how preventive
medications are covered specific to your plan.
Also, a list of all covered preventive medications is
available on CIGNA.com. Preventive medications
are identified by a “PM” symbol within the drug list
search.
prescription drug list has been approved by the U.S. Food and Drug Administration (FDA). This list represents the most commonly If you do not see a specific medication on
this list, please check CIGNA.com. Go to the
“Resources for Members” page, and click “Drug Lists” for the most up-to-date list of Refer to your enrollment information to find out which specific medications are covered The symbols on the list mean .
If your medication has one of the following authorization for coverage of that medication. PA: Prior Authorization may be required for
different reasons. To learn the requirements medication, feel free to give us a call.
QL: Quantity Limit means you may have
coverage for a limited amount of a specific AGE: Age Requirement means an individual
must be within a specific age group for a ST: Step Therapy is a prior authorization
condition before the “ST” medication is myCIGNA.com – a tool to help you
manage your prescription benefits:
When you go to the Pharmacy page of myCIGNA.com,
Look up your specific pharmacy coverage; Research thousands of available medications; Find the actual amounts you will pay for specific Compare medication prices using the Ask a pharmacist questions; Download forms; and more.
Medications Delivered to Your HomeCIGNA Home Delivery Pharmacy is designed for individuals who take prescription medications on a regular basis (including Specialty medications). The benefits of CIGNA Home Delivery Pharmacy Up to a 90-day supply of your medications Delivery of medications to your home at no Licensed pharmacists available to help 24/7 CoachRx: a free tool that is available if you use CIGNA Home Delivery Pharmacy. It can help with reminders, coupons and information about your
prescriptions. Visit CIGNA.com/coachrx to learn
To get an order form, you can go to the Pharmacy page on myCIGNA.com or call 1.800.835.3784, we
To order a specialty medication, visit CIGNA.com
and click “Resources for Members.” You will see the “Specialty Pharmacy” page where the specialty medication order form is located. You can also call 1.800.351.3606 to talk with someone directly.
Health Care Reform and YouThe Patient Protection and Affordable Care Act (PPACA), commonly referred to as “health care reform”, was signed into law on March 23, 2010. This important legislation will result in changes to every American’s health coverage. Some of the changes are taking effect in 2010 and most of the law’s effects CIGNA will comply with all provisions of the law including those that impact your pharmacy coverage plan. For example, depending upon the final government regulations, coverage for medications that have not traditionally been included in pharmacy plans, such as specific over-the-counter (OTC) medications, may be made available at no cost share to you. As with all covered medications, we would require a prescription from your doctor to process the claim under your pharmacy plan To get the most current information visit www.informedonreform.com or CIGNA.com
and look for the “Informed on Reform” link. If You Have QuestionsFeel free to call us at the toll-free number on the back of your CIGNA ID card. We’re here to help. GeNerICs
Add/AdHd
AIds/HIV
GeNerICs
ALZHeIMer’s dIseAse
BIrTH CONTrOL*
* Please check your enrollment materials to determine whether these medications are covered under your specific plan. GeNerICs
BLAdder PrOBLeMs
CArdIOVAsCULAr
HIGH BLOOd PressUre/HeArT MedICATIONs
GeNerICs
CArdIOVAsCULAr (CONTINUED)
HIGH BLOOd PressUre/HeArT MedICATIONs
BLOOd THINNer/ANTI-CLOTTING
CHOLesTerOL LOWerING
GeNerICs
dePressION
dIABeTes
GeNerICs
eYe CONdITIONs
GrOWTH HOrMONes
HeArTBUrN/ULCer
HOrMONe rePLACeMeNT
GeNerICs
HOrMONe rePLACeMeNT (CONTINUED)
INFeCTIONs
GeNerICs
MIGrAINe
MULTIPLe sCLerOsIs
NAUseA ANd VOMITING
OsTeOPOrOsIs
PAIN reLIeF & INFLAMMATOrY dIseAse
GeNerICs
PArKINsON’s dIseAse
PrOsTATe
sCHIZOPHreNIA
GeNerICs
sKIN CONdITIONs
MIsCeLLANeOUs
exCLUsIONs & LIMITATIONs
Plans typical y do not provide coverage for the fol owing, except as required by law or 1. Any medications available over-the-counter that do not require a prescription by Federal or State Law, and any medication that is a pharmaceutical alternative to an over-the-counter medication other than insulin. 2. Medications that are therapeutical y equivalent as determined by the CIGNA HealthCare Pharmacy and Therapeutics Commit ee in which at least one of the medications within the class is available over-the-counter.
3. Any injectable infertility medications, and any injectable medications that require Health Care Professional supervision and are not typical y considered self-administered medications. The fol owing are examples of Health Care Professional supervised medications: Injectables used to treat hemophilia and RSV (respiratory syncytial virus), chemotherapy injectables, and endocrine and 4. Any medications that are experimental or investigational, within the meaning set forth in the summary plan description. 5. Food and Drug Administration (FDA) approved medications used for purposes other than those approved by the FDA unless the medication is recognized for the treatment of the particular indication in one of the standard reference compendia (The United States Pharmacopoeia Drug Information or The American Hospital Formulary Service Drug Information) or in medical literature. Medical literature means scientific studies published in a peer-reviewed national 6. Any prescription and non-prescription supplies (such as ostomy supplies), 7. Any contraceptive medications and prescription appliances for contraception. 8. Implantable contraceptive products. 9. Any fertility medication. 10. Any medications used for treatment of sexual dysfunction, including but not limited to erectile dysfunction, delayed ejaculation, anorgasmia and 11. Any prescription vitamins (other than prenatal vitamins), dietary supplements 12. Medications used for cosmetic purposes, such as medications used to reduce wrinkles, medications to promote hair growth, medications used to control 13. Any diet pil s or appetite suppressants (anorectics). 14. Prescription smoking cessation products. 15. Immunization agents, biological products for al ergy immunization, biological sera, blood, blood plasma and other blood products or fractions and medications 16. Replacement of prescription medications and related supplies due to loss or 17. Medications used to enhance athletic performance. 18. Medications which are to be taken by or administered to a Customer while the Customer is a patient in a licensed hospital, skil ed nursing facility, rest home or similar institution which operates on its premises or al ows to be operated on its premises a facility for dispensing pharmaceuticals. 19. Prescriptions more than one year from the original date of issue.
CIGNA reserves the right to make changes to this Drug List without notice. Your plan may cover additional medications; please refer to your enrollment materials for details. CIGNA does not take responsibility for any medication decisions made by the prescriber or pharmacist. CIGNA may receive payments from manufacturers of certain Preferred Brand medications, and in limited instances, certain Non-Preferred Brand medications, which may or may not be shared with your plan depending on its arrangement with CIGNA. Depending upon plan design, market conditions, the extent to which manufacturer payments are shared with your plan, and other factors as of the date of service, the Preferred Brand medication may or may not represent the lowest cost brand medication within its class for you and/or your plan. “CIGNA”, “CIGNA.com”, “myCIGNA.com” and the ”Tree of Life” logo are registered service marks, and ”CIGNA Home Delivery Pharmacy” is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by CIGNA Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, CIGNA Health and Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. “CIGNA Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug

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