prescription drug list changes - cigna.com...rayos prednisone rescriptor talk with your doctor about...
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908836 a 10/17
Starting January 1, 2018, the medications listed below will change coverage (or cost levels) on Cigna’s Prescription Drug List. Changes are listed by drug list.
If you’re enrolled with Cigna, you can log into myCigna.com to find out how these changes may affect your specific plan.
CIGNA RX ESSENTIAL 5-TIER PRESCRIPTION DRUG LIST
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Adderall XR dextroamphetamine-amphetamine ER
Azilect rasagiline mesylate
Cimzia Humira (requires prior authorization), Enbrel (requires prior authorization), Remicade (requires prior authorization)
Combivir lamivudine/zidovudine
diclofenac sodium 1.5% topical solution diclofenac sodium 1% gel
Emend capsules aprepitant capsules
EpiPen and EpiPen Jr epinephrine auto-injectors
Epivir lamivudine
Fuzeon Talk with your doctor about switching to a covered alternative.
Glatopa Copaxone (requires prior authorization)
Gleevec imatinib mesylate (requires prior authorization)
Invirase Talk with your doctor about switching to a covered alternative.
Maxitrol eye drops neomycin/polymyxin/dexamethasone eye drops
metformin hcl ER (generic Fortamet) metformin hcl ER (generic Glucophage XR)
PRESCRIPTION DRUG LIST CHANGES
Cigna Pharmacy Management® Starting January 1, 2018
Individual and Family PlansCigna Health and Life Insurance CompanyConnecticut General Life Insurance CompanyCigna HealthCare of Arizona, Inc.Cigna HealthCare of Illinois, Inc. andCigna HealthCare of North Carolina, Inc.
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Natroba spinosad
Nilandron nilutamide
Nitrostat nitroglycerin sublingual tablets
Orencia Actemra (requires prior authorization)
Pennsaid 2% Pump diclofenac sodium 1% gel
Rayos prednisone
Rescriptor Talk with your doctor about switching to a covered alternative.
Retrovir zidovudine
Selzentry Talk with your doctor about switching to a covered alternative.
Stelara Cosentyx (requires prior authorization)
Tamiflu capsules oseltamivir phosphate capsules
Tikosyn dofetilide
Trianex triamcinolone ointment
Trizivir abacavir/lamivudine/zidovudine
Vagifem yuvafem
Valcyte 50mg/ml solution valganciclovir hcl 50mg/ml solution
Videx EC didanosine DR
Viracept Talk with your doctor about switching to a covered alternative.
Viramune nevirapine
Viramune XR nevirapine ER
Zebutal 50-325-40mg capsule butalbital/acetaminophen/caffeine 50-325-40mg capsule
Zerit stavudine
Zetia ezetimibe
Ziagen 20mg/ml oral solution abacavir 20mg/ml oral solution
Ziagen 300mg tablet abacavir 300mg tablet
EXCLUDED MEDICATION ADDITIONAL INFORMATION
lidocaine hcl 3% lotion This medication is not approved by the U.S. Food and Drug Administration (FDA). Talk with your doctor. There may be alternative FDA-approved prescription medications or over-the-counter medicines (those that don’t need a prescription) available to treat your condition.
MEDICATION WITH QUANTITY LIMITS ADDITIONAL INFORMATION
epinephrine auto-injectors Your plan only covers this medication up to a certain amount over a certain number of days. Your plan will only cover larger amounts if your doctor requests and receives approval from Cigna.
lidocaine 5% ointment
STEP THERAPY MEDICATION^^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Saizen Humatrope (requires prior authorization)
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Adderall XR dextroamphetamine-amphetamine ER
Azilect rasagiline mesylate
Benicar olmesartan medoxomil
Benicar HCT olmesartan medoxomil/hydrochlorothiazide
Combivir lamivudine/zidovudine
Cordran 0.05% lotion flurandrenolide 0.05% lotion
diclofenac sodium 1.5% topical solution diclofenac sodium 1% gel
Doral quazepam
Edecrin ethacrynic acid
Emend capsules aprepitant capsules
EpiPen and EpiPen Jr epinephrine auto-injectors
Epivir lamivudine
Glatopa Copaxone (requires prior authorization)
Gleevec imatinib mesylate (requires prior authorization)
Invirase Talk with your doctor about switching to a covered alternative.
Maxitrol eye drops neomycin/polymyxin/dexamethasone eye drops
metformin hcl ER (generic Fortamet) metformin hcl ER (generic Glucophage XR)
Naftin 2% cream naftifine hcl 2% cream
Natroba spinosad
Nilandron nilutamide
Nitrostat nitroglycerin sublingual tablets
Orencia Actemra (requires prior authorization)
Pennsaid 2% Pump diclofenac sodium 1% gel
Rayos prednisone
Rescriptor Talk with your doctor about switching to a covered alternative.
Retrovir zidovudine
Selzentry Talk with your doctor about switching to a covered alternative.
Stelara Cosentyx (requires prior authorization)
Tamiflu capsules oseltamivir phosphate capsules
Tikosyn dofetilide
Trianex triamcinolone ointment
Trizivir abacavir/lamivudine/zidovudine
Vagifem yuvafem
Valcyte 50mg/ml solution valganciclovir hcl 50mg/ml solution
Videx EC didanosine DR
CIGNA RX PLUS PRESCRIPTION DRUG LIST
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Viracept Talk with your doctor about switching to a covered alternative.
Viramune nevirapine
Viramune XR nevirapine ER
Zebutal 50-325-40mg capsule butalbital/acetaminophen/caffeine 50-325-40mg capsule
Zerit stavudine
Zetia ezetimibe
Ziagen 300mg tablet abacavir 300mg tablet
EXCLUDED MEDICATION ADDITIONAL INFORMATION
Lidocaine hcl 3% lotion This medication is not approved by the U.S. Food and Drug Administration (FDA). Talk with your doctor. There may be alternative FDA-approved prescription medications or over-the-counter medicines (those that don’t need a prescription) available to treat your condition.
Novacort
MEDICATION WITH QUANTITY LIMITS ADDITIONAL INFORMATION
Epinephrine auto-injectors Your plan only covers this medication up to a certain amount over a certain number of days. Your plan will only cover larger amounts if your doctor requests and receives approval from Cigna.
Lidocaine 5% ointment
STEP THERAPY MEDICATION^^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Saizen Humatrope (requires prior authorization)
CIGNA RX PLUS PRESCRIPTION DRUG LIST (FLORIDA ONLY)
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Adderall XR dextroamphetamine-amphetamine ER
Azilect rasagiline mesylate
Benicar olmesartan medoxomil
Benicar HCT olmesartan medoxomil/hydrochlorothiazide
Cimzia Humira (requires prior authorization), Enbrel (requires prior authorization), Remicade (requires prior authorization)
Cordran 0.05% lotion flurandrenolide 0.05% lotion
diclofenac sodium 1.5% topical solution diclofenac sodium 1% gel
Doral quazepam
Edecrin ethacrynic acid
Emend capsules aprepitant capsules
EpiPen and EpiPen Jr epinephrine auto-injectors
Glatopa Copaxone (requires prior authorization)
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Gleevec imatinib mesylate (requires prior authorization)
Maxitrol eye drops neomycin/polymyxin/dexamethasone eye drops
metformin hcl ER (generic Fortamet) metformin hcl ER (generic Glucophage XR)
Naftin 2% cream naftifine hcl 2% cream
Natroba spinosad
Nilandron nilutamide
Nitrostat nitroglycerin sublingual tablets
Orencia Actemra (requires prior authorization)
Pennsaid 2% Pump diclofenac sodium 1% gel
Rayos prednisone
Simponi Humira (requires prior authorization), Enbrel (requires prior authorization), Remicade (requires prior authorization)
Stelara Cosentyx (requires prior authorization)
Tamiflu capsules oseltamivir phosphate capsules
Tikosyn dofetilide
Trianex triamcinolone ointment
Vagifem yuvafem
Valcyte 50mg/ml solution valganciclovir hcl 50mg/ml solution
Zebutal 50-325-40mg capsule butalbital/acetaminophen/caffeine 50-325-40mg capsule
Zetia ezetimibe
EXCLUDED MEDICATION ADDITIONAL INFORMATION
Lidocaine hcl 3% lotion This medication is not approved by the U.S. Food and Drug Administration (FDA). Talk with your doctor. There may be alternative FDA-approved prescription medications or over-the-counter medicines (those that don’t need a prescription) available to treat your condition.
Novacort
MEDICATION WITH QUANTITY LIMITS ADDITIONAL INFORMATION
Epinephrine auto-injectors Your plan only covers this medication up to a certain amount over a certain number of days. Your plan will only cover larger amounts if your doctor requests and receives approval from Cigna.
Lidocaine 5% ointment
STEP THERAPY MEDICATION^^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Saizen Humatrope (requires prior authorization)
CIGNA RX PREMIERE PRESCRIPTION DRUG LIST
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Adderall XR dextroamphetamine-amphetamine ER
Azilect rasagiline mesylate
Benicar olmesartan medoxomil
Benicar HCT olmesartan medoxomil/hydrochlorothiazide
Combivir lamivudine/zidovudine
Cordran 0.05% lotion flurandrenolide 0.05% lotion
diclofenac sodium 1.5% topical solution diclofenac sodium 1% gel
Doral quazepam
Edecrin ethacrynic acid
Emend capsules aprepitant capsules
EpiPen and EpiPen Jr epinephrine auto-injectors
Epivir lamivudine
Glatopa Copaxone (requires prior authorization)
Gleevec imatinib mesylate (requires prior authorization)
Invirase Talk with your doctor about switching to a covered alternative.
Maxitrol eye drops neomycin/polymyxin/dexamethasone eye drops
metformin hcl ER (generic Fortamet) metformin hcl ER (generic Glucophage XR)
Naftin 2% cream naftifine hcl 2% cream
Natroba spinosad
Nilandron nilutamide
Nitrostat nitroglycerin sublingual tablets
Pennsaid 2% Pump diclofenac sodium 1% gel
Rayos prednisone
Rescriptor Talk with your doctor about switching to a covered alternative.
Retrovir zidovudine
Selzentry Talk with your doctor about switching to a covered alternative.
Stelara Cosentyx (requires prior authorization)
Tamiflu capsules oseltamivir phosphate capsules
Tikosyn dofetilide
Trianex triamcinolone ointment
Trizivir abacavir/lamivudine/zidovudine
Vagifem yuvafem
Valcyte 50mg/ml solution valganciclovir hcl 50mg/ml solution
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Videx EC didanosine DR
Viracept Talk with your doctor about switching to a covered alternative.
Viramune nevirapine
Viramune XR nevirapine ER
Zebutal 50-325-40mg capsule butalbital/acetaminophen/caffeine 50-325-40mg capsule
Zerit stavudine
Zetia ezetimibe
Ziagen 300mg tablet abacavir 300mg tablet
Ziana clindamycin/tretinoin
EXCLUDED MEDICATION ADDITIONAL INFORMATION
Lidocaine hcl 3% lotion This medication is not approved by the U.S. Food and Drug Administration (FDA). Talk with your doctor. There may be alternative FDA-approved prescription medications or over-the-counter medicines (those that don’t need a prescription) available to treat your condition.
Novacort
MEDICATION WITH QUANTITY LIMITS ADDITIONAL INFORMATION
Epinephrine auto-injectors Your plan only covers this medication up to a certain amount over a certain number of days. Your plan will only cover larger amounts if your doctor requests and receives approval from Cigna.
Lidocaine 5% ointment
STEP THERAPY MEDICATION^^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
Saizen Humatrope (requires prior authorization)
^ These medications require approval from Cigna before they’re covered by your plan. If your doctor feels an alternative medication isn’t right for you, he or she can ask Cigna to consider approving coverage of your medication.
^^ This is a Step Therapy medication. Step Therapy medications are not covered by your plan without approval from Cigna. In Step Therapy, you have to try lower-cost alternatives first before the higher-cost brand medication may be covered. Typically, you start by taking generics or lower-cost preferred brands.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., and Cigna HealthCare of North Carolina, Inc. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
908836 a 2018 IFP Drug List Changes Posted Online 10/17 © 2017 Cigna.
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896702 06/16 © 2016 Cigna. Some content provided under license.
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