prescription drug list changes - cigna...nutritional/dietary pregenna, trinaz any generic prenatal...

Generic medications start with a lowercase letter and brand name medications start with a capital letter.

951714 UPDATED_05/21/2021

Changes are being made to Cigna’s Prescription Drug List (formulary) that may affect some of your patients. These changes are listed by formulary name and by effective date.

Below is the list of medications that are changing coverage levels. Please note that the coverage status of medications under our Prescription Drug Lists are always subject to the cost-share requirements, exclusions and coverage limitations of particular benefit plans.

Drug lists used by patients who have coverage through their employer

STANDARD FORMULARY

PRESCRIPTION DRUG LIST CHANGES

For Providers 2021

Start date of change*,**

Drug class Medications moving to preferred brand

June 22, 2021 PAIN RELIEF AND INFLAMMATORY DISEASE Reditrex

May 15, 2021 EYE CONDITIONS Eysuvis

GASTROINTESTINAL/HEARTBURN Sutab

January 1, 2021 AIDS/HIV Juluca

ASTHMA/COPD/RESPIRATORY Bevespi

DIABETES Baqsimi

GASTROINTESTINAL/HEARTBURN Pancreaze

INFECTIONS Epclusa, Harvoni

PAIN RELIEF AND INFLAMMATORY DISEASE Taltz


Drug classMedications becoming non-preferred brand

Generic and/or preferred brand alternatives

June 29, 2021 BLOOD PRESSURE/HEART MEDICATIONS Orladeyo1 Lupron Depot

June 22, 2021 CANCER Orgovyx1 No preferred formulary drug alternatives.

June 15, 2021 GASTROINTESTINAL/HEARTBURN Lubiprostone 8 mcg, 24 mcg capsule Amitiza

June 1, 2021 SKIN CONDITIONS Winlevi 1% cream Generic products (e.g. adapalene; tretinoin; clindamycin-benzoyl peroxide)

Wynzora 0.005%-0.064% cream betamethasone DP, fluocinolone, fluticasone, mometasone, trimacinolone, calcipotriene, calcipotriene-betamethasone DP

STANDARD FORMULARY (cont)





June 1, 2021 URINARY TRACT CONDITIONS Vesicare LS 5 mg/5 mL suspension oxybutynin chloride, oxybutynin chloride ER, darifenacin ER, solifenacin, tolterodine, tolterodine ER, tropsium

May 15, 2021 EYE CONDITIONS Lacrisert Restasis, Restasis Multi-dose, Xiidra

May 2, 2021 PAIN RELIEF AND INFLAMMATORY DISEASE Qdolo tramadol

May 1, 2021 SKIN PREPS Impeklo topical betamethasone dipropionate (augmented) 0.05%, clobetasol propionate 0.05%, halobetasol propionate 0.05%, fluocinolide 0.1%

April 18, 2021 HORMONAL AGENTS Alkindi Sprinkle hydrocortisone 5mg tablet

March 28, 2021 BLOOD PRESSURE/HEART MEDICATIONS Conjupri amlodipine, felodipine, nifedipine, nicardipine

January 1, 2021 AIDS/HIV Intelence1 Talk to your doctor about other alternatives

BLOOD MODIFIERS/BLEEDING DISORDERS Amicar 0.25 g/ml oral solution1 aminocaproic acid 0.25g/ml oral solution

BLOOD PRESSURE/HEART MEDICATIONS Multaq, Norpace CR 150mg Talk to your doctor about other alternatives

CANCER Tabloid Talk to your doctor about other alternatives

ERECTILE DYSFUNCTION Caverject Impulse Syringe MUSE

EYE CONDITIONS Lotemax 0.5% drops loteprednol 0.5% drops

HORMONAL AGENTS Armour Thyroid, Synthroid, Unithroid levothyroxine

INFECTIONS Kitabis Pak1 tobramycin pak 300mg/5ml

SEIZURE DISORDERS Lyrica 20mg/ml oral solution pregabalin 20mg/ml oral solution

SUBSTANCE ABUSE Bunavail buprenorphine/naloxone film or sublingual tablet, Zubsolv

WEIGHT MANAGEMENT Megace ES 625mg/5ml oral suspension megestrol 625ml/5ml oral suspensionStart date of change*,**

Drug class Medications that will need approval (prior authorization)^

June 29, 2021 BLOOD PRESSURE/HEART MEDICATIONS Orladeyo1


June 1, 2021 ASTHMA/COPD/RESPIRATORY Zokinvy

March 14, 2021 CANCER Gavreto

January 1, 2021 BLOOD THINNERS/ANTI-CLOTTING Eliquis4, Pradaxa4, Savaysa4, Xarelto4

PAIN RELIEF AND INFLAMMATORY DISEASE diclofenac 1.3% patch, Flector 1.3% patch5, Voltaren 1% gel5


Drug class Medications that will have a quantity limit




May 2, 2021 PAIN RELIEF AND INFLAMMATORY DISEASE Qdolo





March 14, 2021 CANCER GavretoStart date of change*,**

Drug classMedications that will no longer be covered^^


June 29, 2021 SKIN CONDITIONS Klisyri topical fluorouracil, imiquimod 5% cream

June 22, 2021 GASTROINTESTINAL/HEARTBURN Reltone ursodiol

HORMONAL AGENTS Thyquidity levothyroxine, levoxyl, Levo-T, Unithroid, Euthyrox



June 1, 2021 SKIN CONDITIONS (cont) Wynzora 0.005%-0.064% cream betamethasone DP, fluocinolone, fluticasone, mometasone, trimacinolone, calcipotriene, calcipotriene-betamethasone DP

URINARY TRACT CONDITIONS Vesicare LS 5 mg/5 mL suspension oxybutynin chloride, oxybutynin chloride ER, darifenacin ER, solifenacin, tolterodine, tolterodine ER, tropsium





January 1, 2021 ASTHMA/COPD/RESPIRATORY ProAir HFA7, ProAir RespiClick7, Ventolin HFA7

albuterol HFA

DIABETES Kombiglyze XR8, Onglyza8 metformin, Janumet, Janumet XR, Januvia

EYE CONDITIONS Lumigan7, Travatan Z, Xalatan, Xelpros, Zioptan9

bimatoprost, latanoprost, travoprost

GASTROINTESTINAL/HEARTBURN Creon7, Pertzye, Zenpep7 Pancreaze

Motegrity, Trulance7, Zelnorm Amitiza, Linzess

Sensipar cinacalcet

HORMONAL AGENTS TaperDex dexamethasone 1.5mg tablet

INFECTIONS Baraclude entecavir tablet

Noxafil tablet posaconazole DR 100mg tablet

MULTIPLE SCLEROSIS Ampyra ER7 dalfampridine ER

NUTRITIONAL/DIETARY PreGenna, Trinaz Any generic prenatal vitamin

PAIN RELIEF AND INFLAMMATORY DISEASE Amerge generic triptans (e.g. naratriptan; sumatriptan)






January 1, 2021 PAIN RELIEF AND INFLAMMATORY DISEASE butalbital-acetaminophen 50-300mg tablet butalbutal-acetaminophen 50-325mg tablet

Cosentyx10 Enbrel, Humira, Otezla, Skyrizi, Stelara, Taltz

Frova, Maxalt, Maxalt MLT, Relpax generic triptans (e.g. naratriptan; sumatriptan)

SEIZURE DISORDERS Felbatol11 felbamate

Keppra/Keppra XR11 levetiracetam/levetiracetam ER

Lamictal XR Start Kit11 lamotrigine ER

Lamictal/ODT/XR11 lamotrigine, lamotrigine ER, lamotrigine ODT

Qudexy XR11, Trokendi XR11 topiramate ER

Sabril11 vigabatrin, vigadrone

Topamax11 topiramate

Trileptal11 oxcarbazepine

Zonegran11 zonisamide

SKIN CONDITIONS Apexicon E5, diflorasone, Impoyz5, Olux5, Olux-E5, psorcon

betamethasone, clobetasol, halobetasol

Condylox imiquimod 5% cream packet, podofilox 0.5% topical solution

Cordran5 betamethasone, clobetasol, fluocinolone, fluticasone, halobetasol

Finacea Foam7, Finacea Gel, MetroCream, MetroGel, MetroLotion, Soolantra12

azelaic acid, topical metronidazole

flurandrenolide, hydrocortisone butyrate lipid cream, lotion5, Pandel5

betamethasone, fluocinolone, fluticasone

Sorilux calcitriol, tazarotene, topical calcipotriene

Tridesilon5 alclometasone, desonide, triamcinolone

Xolegel ciclopirox 0.77% gel, ciclopirox 1% shampoo, ketoconazole 2% cream, ketoconazole 2% foam, selenium 2.5% lotion, sodium sulfacetamide 10% shampoo

SLEEP DISORDERS/SEDATIVES Belsomra8 DayvigoURINARY TRACT CONDITIONS Procysbi4 Cystagon


Drug classMedications that will be excluded from coverage

Additional information

January 1, 2021 SKIN CONDITIONS Rosadan Kits azelaic acid, topical metronidazole


VALUE FORMULARY







DIABETES Baqsimi



PAIN RELIEF AND INFLAMMATORY DISEASE Ajovy13, Emgality13, Taltz

SEIZURE DISORDERS Vimpat

URINARY TRACT CONDITIONS Cystagon




June 29, 2021 BLOOD PRESSURE/HEART MEDICATIONS Orladeyo1 No preferred formulary drug alternatives

June 22, 2021 CANCER Orgovyx1 Lupron Depot










ERECTILE DYSFUNCTION Caverject Impulse Syringe MUSE

HORMONAL AGENTS Unithroid 75mcg tablet levothyroxine




WEIGHT MANAGEMENT Megace ES 625mg/5ml oral suspension megestrol 625ml/5ml oral suspension


VALUE FORMULARY (cont)








HORMONAL AGENTS Tirosint, Tirosint-Sol






















January 1, 2021 ASTHMA/COPD/RESPIRATORY Advair HFA7, Breo Ellipta7 Dulera, fluticasone-salmeterol (generic Advair Diskus), fluticasone-salmeterol (generic Airduo), Symbicort, Wixela Inhub

ProAir HFA7, ProAir RespiClick7 albuterol HFA







January 1, 2021 CONTRACEPTION PRODUCTS Balcoltra, Natazia, Slynd, Taytulla Generic oral contraceptives (e.g. levonorgestrel-ethinyl estradiol)

DIABETES GlucaGen HypoKit7, Gvoke Baqsimi, Glucagon Emergency Kit

EYE CONDITIONS Cequa, Restasis MultiDose7, Xiidra7 Restasis

Travatan Z, Xalatan, Xelpros, Zioptan9 bimatoprost, latanoprost, travoprost


Linzess7, Motegrity, Trulance7, Zelnorm Amitiza

Sensipar cinacalcet







butalbital-acetaminophen 50-300mg tablet butalbital-acetaminophen 50-325mg tablet


diclofenac 1.3% patch, Flector 1.3% patch5, Voltaren 1% gel5

diclofenac 1% gel, generic oral NSAIDs (e.g. celecoxib; meloxicam)











SKIN CONDITIONS Apexicon E5, diflorasone, Impoyz5, Olux5, Olux-E5, Psorcon






LEGACY (STANDARD) FORMULARY




January 1, 2021 SKIN CONDITIONS Finacea foam, Finacea gel, MetroCream, MetroGel, MetroLotion, Soolantra12






SLEEP DISORDERS/SEDATIVES Belsomra8 DayvigoURINARY TRACT CONDITIONS Procysbi4 Cystagon




January 1, 2021 ALLERGY/NASAL SPRAYS Beconase AQ, flunisolide, mometasone, Nasonex, Omnaris, Qnasl, Qnasl Children, Xhance, Zetonna

generics products available over-the-counter (e.g. budesonide, fluticasone)

fluticasone 50 mcg spray generics products available over-the-counter (e.g. budesonide)

EYE CONDITIONS azelastine, Bepreve, epinastine, Lastacaft, Pazeo, Zerviate

products available over-the-counter (e.g. Alaway, Pataday)

SKIN CONDITIONS Rosadan Kits azelaic acid, topical metronidazole








DIABETES Baqsimi

GASTROINTESTINAL/HEARTBURN pancreaze

INFECTIONS Epclusa

Harvoni






SKIN CONDITIONS Klisyri topical fluorouracil, imiquimod 5% cream, Fluoroplex


LEGACY (STANDARD) FORMULARY






GASTROINTESTINAL/HEARTBURN Reltone ursodiol





May 15, 2021 EYE CONDITIONS Lacrisert Restasis, Restasis Multi-dose, Xiidra






ASTHMA/COPD/RESPIRATORY ProAir HFA, ProAir RespiClick, Ventolin HFA albuterol HFA

BLOOD MODIFIERS/BLEEDING DISORDERS Amicar 0.25 g/ml oral solution1 aminocaproic acid 0.25g/ml oral solution

BLOOD PRESSURE/HEART MEDICATIONS MULTAQ, Norpace CR 150mg Talk to your doctor about other alternatives

CANCER Tabloid Talk to your doctor about other alternatives


ERECTILE DYSFUNCTION Caverject Impulse Syringe1 MUSE


Lumigan bimatoprost, latanoprost, travoprost

GASTROINTESTINAL/HEARTBURN Creon, Zenpep Pancreaze

Trulance Amitiza, Linzess



MULTIPLE SCLEROSIS Ampyra ER dalfampridine ER

PAIN RELIEF AND INFLAMMATORY DISEASE Cosentyx5 Enbrel, Humira, Otezla, Skyrizi, Stelara, Taltz

SEIZURE DISORDERS Lamictal XR Start Kit lamotrigine ER

Lyrica 20mg/ml oral solution pregabalin 20mg/ml oral solution

LEGACY (STANDARD) FORMULARY (cont)





January 1, 2021 SEIZURE DISORDERS (cont) Qudexy XR, Trokendi XR topiramate ER

Sabril vigabatrin, vigadrone

SKIN CONDITIONS Finacea foam, Soolantra14 azelaic acid, topical metronidazole

Psorcon betamethasone, clobetasol, halobetasol

SLEEP DISORDERS/SEDATIVES Belsomra8 Dayvigo






June 22, 2021 GASTROINTESTINAL/HEARTBURN Reltone

HORMONAL AGENTS Thyquidity

PAIN RELIEF AND INFLAMMATORY DISEASE Reditrex

June 15, 2021 URINARY TRACT CONDITIONS Lubiprostone 8 mcg, 24 mcg capsule


SKIN CONDITIONS Winlevi 1% cream

Wynzora 0.005%-0.064% cream


May 1, 2021 SKIN PREPS Impeklo

April 18, 2021 HORMONAL AGENTS Alkindi Sprinkle

March 28, 2021 BLOOD PRESSURE/HEART MEDICATIONS Conjupri


January 1, 2021 ALLERGY/NASAL SPRAYS carbinoxamine, EpiPen, EpiPen Jr, RyVent

ANXIETY/DEPRESSION/BIPOLAR DISORDER Anafranil, Aplenzin, Ativan, Cymbalta, Lexapro, Pamelor, Parnate, Pexeva, Tofranil, Wellbutrin XL

ASTHMA/COPD/RESPIRATORY Elixophyllin, Proventil HFA, Zyflo, Zyflo CR

ATTENTION DEFICIT HYPERACTIVITY DISORDER Desoxyn, Dexedrine

BLOOD PRESSURE/HEART MEDICATIONS Betapace, Cardizem, Cardizem CD, Consensi, Isordil, Isordil Titradose, Lanoxin

BLOOD THINNERS/ANTI-CLOTTING Eliquis, Pradaxa, Savaysa, Xarelto, Yosprala

CANCER Nilandron

CHOLESTEROL MEDICATIONS Antara, Fenoglide, Lipitor

COUGH/COLD MEDICATIONS benzonatate, TussiCaps

DIABETES Fortamet, Glumetza, metformin ER Gastric, metformin ER Osmotic

DIURETICS Edecrin

EYE CONDITIONS Travatan Z, Vyzulta, Xalatan, Xelpros, Zioptan9

GASTROINTESTINAL/HEARTBURN Anusol-HC suppository, Cortifoam, Librax, Lotronex, Marinol, Motegtrity, Nexium, Omeclamox-Pak, omeprazole, Pepcid suspension, tablet, Pertzye, Prevacid SoluTab, Pylera, Rowasa, Sensipar, Uceris rectal foam, Zegerid capsule, packet, Zelnorm, Zofran, Zuplenz

HORMONAL AGENTS DDAVP nasal spray, solution, tablet, Dexpak, Rayos, TaperDex, Uceris tablet

LEGACY (STANDARD) FORMULARY (cont)




January 1, 2021 INFECTIONS Augmentin, Baraclude, Diflucan, Doryx, E.E.S. 200, EryPed 400, Mepron, Minocin, Mycobutin, Noxafil tablet, Oracea, Sitavig, Solodyn, Sporanox, Targadox, Valcyte, Vancocin, Vibramycin, Zovirax capsule, suspension, tablet

MISCELLANEOUS Horizant

NUTRITIONAL/DIETARY PreGenna, Trinaz

PAIN RELIEF AND INFLAMMATORY DISEASE Allzital, Amerge, Amrix, BUPAP, Butalbital-acetaminophen 50-300mg tablet, Cambia, chlorzoxazone, ConZip, D.H.E.45, diclofenac 1.3% patch5, 1.5% topical solution, Duexis, Ergomar, Fenortho 200 mg capsule, Flector 1.3 % patch5, Frova, Gralise, Imitrex, Indocin, levorphanol, Lorzone, Maxalt, Maxalt MLT, Migranal, Naprelan, naproxen CR, Onzetra Xsail, Pennsaid, Relpax, roxicodone, Soriatane, Sprix, Tivorbex, Treximet, Vanatol LQ, Vimovo , Vivlodex, Voltaren 1% gel5, Zembrace Symtouch, Zipsor, Zomig, Zomig ZMT, Zorvolex

PARKINSON’S DISEASE Lodosyn, Requip XL, Zelapar

SCHIZOPHRENIA/ANTI-PSYCHOTICS FazaClo, Geodon, Versacloz, Zyprexa, Zyprexa Zydis

SEIZURE DISORDERS Mysoline

SKIN CONDITIONS Aldara, Anusol-HC cream, Apexicon E5, Bensal HP, Benzaclin, Carac, Clindage, Clobex shampoo, spray, topical lotion, Condylox, Cordran5, Cutivate, diclofenac 3% gel, diflorasone, Ertaczo, Exelderm, Extina, Finacea gel, flurandrenolide, Halog cream, ointment, hydrocortisone butyrate lipid cream, lotion5, Impoyz5, Jublia, Kenalog 0.147 mg/gm spray, Kerydin, Locoid, Loprox 0.77% cream, 1% shampoo, Luzu, MetroCream, MetroGel, MetroLotion, Noritate, Olux5, Olux-E5, Oxistat, Pandel5, Penlac, Prudoxin, Sernivo, Sorilux, Trainex, Tridesilon5, Ultravate, Vanos, Verdeso, Vusion, Xerese, Xolegel, Ziana, Zonalon, Zovirax cream, ointment, Zyclara

SLEEP DISORDERS/SEDATIVES Ambien, Ambien CR, Edular, Intermezzo, Nuvigil, Provigil, Restoril, Zolpimist

SUBSTANCE ABUSE EvzioStart date of change*,**







Drug classMedications being added to Step Therapy Program^,^^


June 29, 2021 SKIN CONDITIONS Klisyri topical fluorouracil, imiquimod 5% cream, Fluoroplex







PERFORMANCE FORMULARY






April 1, 2021 CANCER Riabni



DIABETES Baqsimi


















BLOOD PRESSURE/HEART MEDICATIONS MULTAQ Talk to your doctor about other alternatives






PERFORMANCE FORMULARY (cont)





January 1, 2021 SUBSTANCE ABUSE Probuphine Talk to your doctor about other alternativesStart date of change*,**







PAIN RELIEF AND INFLAMMATORY DISEASE diclofenac 1.3% patch, Flextor 1.3% patch5, Voltaren 1% gel5


























January 1, 2021 ASTHMA/COPD/RESPIRATORY ProAir HFA7, ProAir RespiClick7, Ventolin HFA7

albuterol HFA


EYE CONDITIONS Lumigan7, Travatan Z, Xalatan, Xelpros, Zioptan9

bimatoprost, latanoprost, travoprost

GASTROINTESTINAL/HEARTBURN Creon7, Pertzye7, Zenpep7 Pancreaze

Motegrity, Trulance7, Zelnorm Amitiza, Linzess

Sensipar cinacalcet






PAIN RELIEF AND INFLAMMATORY DISEASE Amerge, Frova, Maxalt, Maxalt MLT, Relpax generic triptans (e.g. naratriptan; sumatriptan)

butalbital-acetaminophen 50-300mg tablet butalbital-acetaminophen 50-325mg tablet















Finacea7, MetroCream, MetroGel, MetroLotion, Soolantra12


flurandrenolide, Pandel5 betamethasone, fluocinolone, fluticasone

hydrocortisone butyrate lipid cream, lotion5 betamethasone, fluocinolone, fluticasone

Sorilux calcitriol, tazarotene, topical calcipotriene


ADVANTAGE FORMULARY




January1, 2021 SKIN CONDITIONS (cont) Tridesilon5 alclometasone, desonide, triamcinolone



URINARY TRACT CONDITIONS Procysbi4 CystagonStart date of change*,**












DIABETES Baqsimi



PAIN RELIEF AND INFLAMMATORY DISEASE Ajovy13, Emgality13, Taltz

SEIZURE DISORDERS VIMPAT












ADVANTAGE FORMULARY (cont)










HORMONAL AGENTS Unithroid 75mcg tablet levothyroxine




Probuphine Talk to your doctor about other alternatives









HORMONAL AGENTS Tirosint, Tirosint-SOL





















June 1, 2021 SKIN CONDITIONS (cont) Wynzora 0.005%-0.064% cream betamethasone DP, fluocinolone, fluticasone, mometasone, trimacinolone, calcipotriene, calcipotriene-betamethasone DP






January 1, 2021 ASTHMA/COPD/RESPIRATORY Advair HFA7, Breo Ellipta7 Dulera, fluticasone-salmeterol (generic Advair Diskus), fluticasone-salmeterol (generic Airduo), Symbicort, Wixela Inhub


CONTRACEPTION PRODUCTS Balcoltra, Natazia, Slynd, Taytulla Generic oral contraceptives (e.g. levonorgestrel-ethinyl estradiol)






Sensipar cinacalcet







butalbital-acetaminophen 50-300mg tablet butalbutal-acetaminophen 50-325mg tablet


diclofenac 1.3% patch, Flector 1.3% patch5, Voltaren 1% gel5

diclofenac 1% gel, generic oral NSAIDs (e.g. celecoxib; meloxicam)






January 1, 2021 PAIN RELIEF AND INFLAMMATORY DISEASE (cont)















Finacea, MetroCream, MetroGel, MetroLotion, Soolantra12










January 1, 2021 ALLERGY/NASAL SPRAYS Beconase AQ, flunisolide, mometasone, Nasonex, Omnaris, Qnasl, Qnasl Children, Xhance, Zetonna

generics products available over-the-counter (e.g. budesonide, fluticasone)

EYE CONDITIONS azelastine, Bepreve, epinastine, Lastacaft, Pazeo, Zerviate

products available over-the-counter (e.g. Alaway, Pataday)



LEGACY (PERFORMANCE) FORMULARY









DIABETES Baqsimi








SKIN CONDITIONS Klisyri topical fluorouracil, imiquimod 5% cream, Fluoroplex



GASTROINTESTINAL/HEARTBURN Reltone ursodiol










ASTHMA/COPD/RESPIRATORY ProAir HFA, ProAir RespiClick, Ventolin HFA albuterol HFA

BLOOD PRESSURE/HEART MEDICATIONS MULTAQ Talk to your doctor about other alternatives

LEGACY (PERFORMANCE) FORMULARY (cont)





January 1, 2021 DIABETES Kombiglyze XR14, Onglyza14 metformin, Janumet, Janumet XR, Januvia


Lumigan bimatoprost, latanoprost, travoprost

GASTROINTESTINAL/HEARTBURN Creon, Zenpep Pancreaze

Trulance Amitiza, Linzess

HORMONAL AGENTS Armour Thyroid, Synthroid, Unithroid 75mcg tablet

levothyroxine


MULTIPLE SCLEROSIS Ampyra ER dalfampridine ER

PAIN RELIEF AND INFLAMMATORY DISEASE Cosentyx1,4 Enbrel, Humira, Otezla, Skyrizi, Stelara, Taltz

SEIZURE DISORDERS Lamictal XR Start Kit lamotrigine ER

Lyrica 20mg/ml oral solution pregabalin 20mg/ml oral solution

Qudexy XR, Trokendi XR topiramate ER


SKIN CONDITIONS Finacea foam, Soolantra14 azelaic acid, topical metronidazole

Psorcon betamethasone, clobetasol, halobetasol



Probuphine Talk to your doctor about other alternatives





June 22, 2021 GASTROINTESTINAL/HEARTBURN Reltone

HORMONAL AGENTS Thyquidity

PAIN RELIEF AND INFLAMMATORY DISEASE Reditrex

June 15, 2021 GASTROINTESTINAL/HEARTBURN Lubiprostone 8 mcg, 24 mcg capsule


SKIN CONDITIONS Winlevi 1% cream

Wynzora 0.005%-0.064% cream


May 1, 2021 SKIN PREPS Impeklo

April 18, 2021 HORMONAL AGENTS Alkindi Sprinkle

March 28, 2021 BLOOD PRESSURE/HEART MEDICATIONS Conjupri






January 1, 2021 ANXIETY/DEPRESSION/BIPOLAR DISORDER Anafranil, Aplenzin, Ativan, Cymbalta, Lexapro, Pamelor, Parnate, Pexeva, Tofranil, Wellbutrin XL

ASTHMA/COPD/RESPIRATORY Elixophyllin, Proventil HFA, Zyflo, Zyflo CR

ATTENTION DEFICIT HYPERACTIVITY DISORDER Desoxyn, Dexedrine

BLOOD PRESSURE/HEART MEDICATIONS Betapace, Cardizem, Cardizem CD, Consensi, Isordil, Isordil Titradose, Lanoxin

BLOOD THINNERS/ANTI-CLOTTING Eliquis, Pradaxa, Savaysa, Xarelto, Yosprala

CANCER Aldara, Nilandron, Zyclara

CHOLESTEROL MEDICATIONS Antara, Fenoglide, Lipitor

COUGH/COLD MEDICATIONS benzonatate, TussiCaps

DIABETES Fortamet, Glumetza, metformin ER Gastric, metformin ER Osmotic

DIURETICS Edecrin

EYE CONDITIONS Travatan Z, Vyzulta, Xalatan, Xelpros, Zioptan9

GASTROINTESTINAL/HEARTBURN Anusol-HC suppository, Cortifoam, Librax, Lotronex, Marinol, Motegrity, Nexium, Omeclamox-Pak, omeprazole, Pepcid suspension, tablet, Pertzye, Prevacid SoluTab, Pylera, Rowasa, Sensipar, Uceris rectal foam, Zegerid capsule, packet, Zelnorm, Zofran, Zuplenz

HORMONAL AGENTS DDAVP nasal spray, solution, tablet, Dexpak, Rayos, TaperDex, Uceris tablet

INFECTIONS Augmentin, Baraclude, Diflucan, Doryx, E.E.S. 200 EryPed 400, Mepron, Minocin, Mycobutin, Noxafil tablet, Oracea, Sitavig, Solodyn, Sporanox, Targadox, Valcyte, Vancocin, Vibramycin, Zovirax capsule, suspension, tablet

MISCELLANEOUS Horizant

NUTRITIONAL/DIETARY PreGenna, Trinaz

PAIN RELIEF AND INFLAMMATORY DISEASE Allzital, Amerge, Amrix, BUPAP, butalbital-acetaminophen 50-300mg tablet, Cambia, chlorzoxazone, ConZip, D.H.E.45, diclofenac 1.3% patch5, 1.5% topical solution, Duexis, Ergomar, Fenortho 200 mg capsule, Flector 1.3% patch5, Frova, Gralise, Imitrex, Indocin, levorphanol, Lorzone, Maxalt, Maxalt MLT, Migranal, Naprelan, naproxen CR, Onzetra Xsail, Pennsaid, Relpax, Roxicodone, Soriatane, Sprix, Tivorbex, Treximet, Vanatol LQ, Vimovo, Vivlodex, Votaren 1% gel5, Zembrace Symtouch, Zipsor, Zomig, Zomig ZMT, Zorvolex

PARKINSON'S DISEASE Lodosyn, Requip XL, Zelapar

SCHIZOPHRENIA/ANTI-PSYCHOTICS FazaClo, Geodon, Versacloz, Zyprexa, Zyprexa Zydis

SEIZURE DISORDERS Mysoline

SKIN CONDITIONS Anusol-HC cream, Apexicon E5, Bensal HP, Benzaclin, Carac, Clindagel, Clobex shampoo, spray, topical lotion, Condylox, Cordran5, Cutivate, diclofenac 3% gel, diflorasone, Ertaczo, Exelderm, Extina, Finacea gel, flurandrenolide, Halog cream, ointment, hydrocortisone butyrate lipid cream, lotion5, Impoyz5, Jublia, Kenalog 0.147mg/gm spray, Kerydin, Locoid, Loprox 0.77% cream, 1% shampoo, Luzu, MetroCream, MetroGel, MetroLotion, Noritate, Olux5, Olux-E5, Oxistat, Pandel5, Penlac, Prudoxin, Sernivo, Sorilux, Trainex, Tridesilon2, Ultravate, Vanos, Verdeso, Vusion, Xerese, Xolegel, Ziana, Zonalon, Zovirax cream, ointment

SLEEP DISORDERS/SEDATIVES Ambien, Ambien CR, Edular, Intermezzo, Nuvigil, Provigil, Restoril, Zolpimist


CIGNA TOTAL SAVINGS FORMULARY




January 1, 2021 SUBSTANCE ABUSE Evzio























DIABETES Baqsimi

Jentadueto15, Jentadueto XR15, Tradjenta15


HORMONAL AGENTS Imvexxy, Intrarosa


PAIN RELIEF AND INFLAMMATORY DISEASE Ajovy13, Cimzia, Emgality13, Olumiant

SEIZURE DISORDERS VIMPAT







CIGNA TOTAL SAVINGS FORMULARY (cont)













January 1, 2021 AIDS/HIV Atripla1, Descovy1, Intelence1, Selzentry1, Symtuza1, Truvada1

Talk to your doctor about other alternatives

ERECTILE DYSFUNCTION Caverject Impulse Syringe Talk to your doctor about other alternatives






















July 1, 2021 DIABETES Jentadueto, Jentadueto XR, Tradjenta metformin














May 1, 2021 SKIN PREPS Impeklo topical betamethasone (augmented) 0.05%, clobetasol 0.05%, halobetasol propionate 0.05%, fluocinolide 0.1%



January 1, 2021 ANXIETY/DEPRESSION/BIPOLAR DISORDER Forfivo XL bupropion XL tablet

Paxil CR paroxetine ER

ASTHMA/COPD/RESPIRATORY Advair HFA7, Breo Ellipta7 Dulera, fluticasone-salmeterol (generic Advair Diskus), fluticasone-salmeterol (generic Airduo), Symbicort, Wixela Inhub

Kalydeco5, Orkambi5, Symdeko5 Trikafta3


ATTENTION DEFICIT HYPERACTIVITY DISORDER Intuniv guanfacine ER

Strattera atomoxetine capsule

BLOOD PRESSURE/HEART MEDICATIONS Ranexa ranolazine ER

CANCER Pomalyst5 Revlimid

CHOLESTEROL MEDICATIONS Lovaza omega-3 acid ethyl esters capsule

CONTRACEPTION PRODUCTS Balcoltra, Loseasonique, Natazia, Quartette, Slynd, Taytulla7

Generic oral contraceptives (e.g. levonorgestrel-ethinyl estradiol)

Beyaz, Safyral, Yasmin 28, Yaz Generic oral contraceptives (e.g. drospirenone-ethinyl estradiol-levomefolate)

Depo-Provera medroxyprogesterone

Estrostep FE Generic oral contraceptives (e.g. Tilia FE, Tri-Legest FE)






January 1, 2021 CONTRACEPTION PRODUCTS Generess FE, Layolis FE, Loestrin FE, Miastrin 24 FE

Generic oral contraceptives (e.g. norethindrone-ethinyl estradiol-FE)

Loestrin Generic oral contraceptives (e.g. norethindrone-ethinyl estradiol)

Mirapex ER 4.5mg tablet pramipexole ER 4.5mg tablet

NuvaRing etonogestrel-ethinyl estradiol vaginal ring

Ortho Micronor Generic oral contraceptives (e.g. norethindrone 0.35mg)

Prenatabas FA Pretab 29mg-1mg tablet


Janumet8, Janumet XR8, Januvia8 metformin, Jentadueto, Jentadueto XR, Tradjenta


FML Liquifilm fluorometholone eye drops

Lotemax drops loteprednol 0.5% drops


GASTROINTESTINAL/HEARTBURN Apriso mesalamine ER capsule

Carafate7 sucralfate

Creon7, Pertzye, Zenpep7 Pancreaze


Sensipar cinacalcet

HORMONAL AGENTS Armour Thyroid, Synthroid7, Tirosint, Tirosint Sol, Unithroid7

levothyroxine

Cortef hydrocortisone tablet

Minivelle estradiol patch

TaperDex dexamethasone 1.5mg tablet

Vivelle-Dot estradiol patch



Sulfatrim sulfamethoxazole-TMP suspension

Tamiflu oseltamivir


Avonex7, Extavia7, Plegridy7, Rebif7 Betaseron, glatiramer, Glatopa

Gilenya7, Mavenclad, Mayzent7, Tecfidera7, Zeposia7

Vumerity


VitaTrue Combo Pack Prena1 True Combo Pack

PAIN RELIEF AND INFLAMMATORY DISEASE Amerge, Frova, Maxalt, Maxalt MLT, Relpax generic triptans (e.g. naratriptan; sumatriptan)






January 1, 2021 PAIN RELIEF AND INFLAMMATORY DISEASE (cont)

butalbital-acetaminophen 50-300mg tablet butalbutal-acetaminophen 50-325mg tablet

diclofenac 1.3% patch, Flector 1.3% patch3,5, Voltaren 1% gel5

diclofenac 1% gel, oral generic Rx NSAIDs (e.g. celecoxib; meloxicam)

Humira7 Actemra, Cimzia, Cosentyx, Enbrel, Simponi 100mg, Stelara, Tremfya

Ilumya7, Otezla7, Skyrizi7 Cimzia, Cosentyx, Enbrel, Olumiant, Stelara, Tremfya

Kevzara, Rinvoq7 Actemra, Cimzia, Enbrel, Olumiant

Orencia Actemra, Cimzia, Cosentyx, Enbrel, Olumiant, Stelara

Uloric febuxostat

Xeljanz7, Xeljanz XR7 Actemra, Cimzia, Cosentyx, Enbrel, Olumiant, Simponi 100mg, Stelara

SEIZURE DISORDERS Carbatrol, Tegretol XR carbamazepine ER capsule

Depakote divalproex

Depakote ER divalproex ER

Depakote Sprinkle divalproex DR sprinkle capsule

Felbatol11 felbamate

Keppra/Keppra X11 levetiracetam/levetiracetam ER



Onfi clobazam






SKIN CONDITIONS Apexicon E5, diflorasone, Impoyz5, Olux5, Olux-E5, Psorcon7




Elidel pimecrolimus cream

Finacea, MetroCream, MetroGel, MetroLotion, Soolantra12




CIGNA NATIONAL PRESCRIPTION DRUG LIST






January 1, 2021 SKIN CONDITIONS (cont) Tridesilon5 alclometasone, desonide, triamcinolone



TRANSPLANT MEDICATIONS Myfortic mycophenolic acid

Prograf tacrolimus




January 1, 2021 ALLERGY/NASAL SPRAYS Beconase AQ, Nasonex, Omnaris, Qnasl, Qnasl Children, Xhance, Zetonna,

flunisolide, fluticasone, mometasone

flunisolide, mometasone spray generics products available over-the-counter (e.g. budesonide, fluticasone)

fluticasone 50 mcg spray generics products available over-the-counter (e.g. budesonide)

EYE CONDITIONS azelastine, epinastine products available over-the-counter (e.g. Alaway, Pataday)

Bepreve, Lastacaft, Pazeo, Zerviate azelastine, epinastine eye drops




May 7, 2021 CANCER Tabrecta1

April 16, 2021 BLOOD PRESSURE/HEART MEDICATIONS Verquvo

April 2, 2021 CANCER Xtandi

MULTIPLE SCLEROSIS Plegridy1

March 19, 2021 MULTIPLE SCLEROSIS Mayzent 0.25 MG Starter Pack

February 19, 2021 MULTIPLE SCLEROSIS Aubagio1




April 2, 2021 URINARY TRACT CONDITIONS Gemtesa 75mg tablet darifenacin er, oxybutynin chloride er, tolterodine tartrate er, trospium chloride, Myrbetriq, Toviaz ER

March 19, 2021 BLOOD PRESSURE/HEART MEDICATIONS Orladeyo1 Takhzyro

INFECTIONS Dificid 40mg/ml suspension vancomycin hcl

February 5, 2021 EYE CONDITIONS Eysuvis 0.25% Eye Drops loteprednol etabonate, artificial tears

January 22, 2021 INFECTIONS Alinia 500mg Tablet nitazoxanide


CIGNA NATIONAL PRESCRIPTION DRUG LIST cont.




January 16, 2021 HORMONAL AGENTS Mycapssa DR 20 mg capsule1 Somatuline Depot

PARKINSON’S DISEASE Ongentys 50 mg capsule entacapone



May 17, 2021 BLOOD MODIFIERS/BLEEDING DISORDERS Nyvepria1

April 1, 2021 EYE CONDITIONS Eysuvis 0.25% ophthalmic suspension

Lacrisert

HORMONAL AGENTS Synarel1

January 16, 2021 HORMONAL AGENTS Mycapssa DR 20 mg capsule1

PARKINSON’S DISEASE Ongentys 50 mg capsule

January 15, 2021 ASTHMA/COPD/RESPIRATORY Zokinvy1



May 17, 2021 CANCER Vitrakvi1

HORMONAL AGENTS Xyosted

NUTRITIONAL/DIETARY Nascobal 500mcg/0.1ml nasal spray device

PAIN RELIEF AND INFLAMMATORY DISEASE Humira 80mg/0.8ml pen1

SKIN CONDITIONS Condylox 0.5% gel

May 17, 2021 SLEEP DISORDERS/SEDATIVES Hetlioz LQ 4mg/ml oral suspension1

May 3, 2021 NUTRITIONAL/DIETARY Calcium 667mg

Phoslyra 667mg/5ml oral solution

Renvela

April 15, 2021 DIABETES Ozempic 4mg/3ml (1.34mg/ml) pre-filled pen

April 1, 2021 ANXIETY/DEPRESSION/BIPOLAR DISORDER Pexeva

PAIN RELIEF AND INFLAMMATORY DISEASE Xeljanz 1 mg/ml oral solution1

SKIN CONDITIONS Gentamicin 0.1% cream, ointment

March 15, 2021 ASTHMA/COPD/RESPIRATORY Trikafta 100/50/75 mg-150 mg tablets1

BLOOD PRESSURE/HEART MEDICATIONS Verquvo

NUTRITIONAL/DIETARY Velphoro 500 mg tablets

SLEEP DISORDERS/SEDATIVES Xyrem1

Xywav1

March 2, 2021 ANTIPARKINSON DRUGS Inbrija 42 mg capsules1

ASTHMA/COPD/RESPIRATORY Trelegy Ellipta 200/62.5/25 mcg

Zokinvy1

HORMONAL AGENTS Divigel 1.25 gram

PARKINSON’S DISEASE Ongentys 25 mg, 50 mg capsules





March 2, 2021 SEIZURE DISORDERS Fintepla 2.2 mg/ml oral solution1

February 15, 2021 CONTRACEPTION PRODUCTS Phexxi

February 5, 2021 EYE CONDITIONS Eysuvis 0.25% ophthalmic suspension




April 15, 2021 INFECTIONS Vibramycin cap, suspension, and syrup Doxycycline, Minocycline

SKIN CONDITIONS Kerydin generic (Tavaborale) Ciclodan 8% topical solution (branded generic), ciclopirox 8% topical solution, ciclopirox 8% treatment kit




May 16, 2021 AIDS/HIV Cabenuva suspension atazanavir, lamivudine, Dovato, Edurant, Juluca, Prezista, Tivicay

CANCER Tepmetko1 Tabrecta

CONTRACEPTION PRODUCTS Tyblume altavera, aviane, falmina, lessina, levonor-eth etrad, portia, vienva

PAIN RELIEF AND INFlAMMATORY DISEASE Reditrex methotrexage inj, Rasuvo

SKIN CONDITIONS Tazarotene 0.1% foam tazarotene cream, Tazorac gel

TRANSPLANT MEDICATIONS Lupkynis1 mycophenolate, prednisone

April 16, 2021 CANCER Orgovyx1 Eligard, Firmagon

Riabni 100mg/10ml, 500mg/50ml vial1 Ruxience

GASTROINTESTINAL/HEARTBURN Reltone 200 mg, 400 mg capsule ursodiol

HORMONAL AGENTS Thyquidity euthyrox, levo-t, levothyroxine, levoxyl

SKIN CONDITIONS Impeklo 0.05% Lotion betamethasone dipropionate, clobetasol, desonide, desoximetasone, diflorasone, fluocinonide, halcinonide

Klisyri 1% ointment packet diclofenac 3% gel, fluorouracil 5% cream, solution, imiquimod 5% cream

April 1, 2021 ANXIETY/DEPRESSION/BIPOLAR DISORDER Pexeva, Viibryd citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

BLOOD PRESSURE/HEART MEDICATIONS Bystolic atenolol, carvedilol, metoprolol succinate

Edarbi candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan

Edarbyclor candesartan-HCTZ, irbesartan-HCTZ, losartan-HCTZ, olmesartan-HCTZ, telmisartan-HCTZ, valsartan-HCTZ, chlorthalidone plus valsartan

CONTRACEPTION PRODUCTS Annovera generic oral contraceptives, Xulane patches

Balcoltra Aviane, Larissia, Lessina, levonorgestrel-eth estradiol, Sronyx, Vienva

Lo Loestrin FE Blisolvi FE, Blisolvi 24 FE, Hailey FE, Junel FE, Larin FE, Melodetta 24 FE, norethindrone-eth estradiol FE






April 1, 2021 CONTRACEPTION PRODUCTS Natazia Blisolvi FE, drospirenone-ethinyl estradiol, Estarylla, Junel FE, Sprintec, Tri-Sprintec

Slynd generic progestin-only oral contraceptives

Taytulla Gemmily, norethindrone-eth estradiol FE

DIABETES Afrezza Humalog, Lyumjev

GASTROINTESTINAL/HEARTBURN Clenpiq Gavilyte-G, peg-electrolyte solution, peg-3350, Trilyte with Flavor packets.

Golytely Packets Gavilyte-G, peg-electrolyte solution, peg-3350, Trilyte with Flavor packets.

Plenvu Gavilyte-G, peg-electrolyte solution, peg-3350, Trilyte with Flavor packets.

Suprep Gavilyte-G, peg-electrolyte solution, peg-3350, Trilyte with Flavor packets.

HORMONAL AGENTS Osphena estradiol (cream), Yuvafem, Estring, Premarin (cream)

Premarin Tablets estradiol tablets

Premphase Amabelz, estradiol-norethindrone acetate, Fyavolv, Jinteli, Mimvey, norethindrone-ethinyl estradiol

Prempro Amabelz, estradiol-norethindrone acetate, Fyavolv, Jinteli, Mimvey, norethindrone-ethinyl estradiol

SKIN CONDITIONS Drysol Over the counter alternatives.

March 16, 2021 GASTROINTESTINAL/HEARTBURN Lubiprostone 8 mcg, 24 mcg capsule Linzess, Trulance

PAIN RELIEF AND INFLAMMATORY DISEASE Zolmitriptan 2.5 mg, 5 mg Nasal Spray sumatriptan nasal, Zomig nasal

SKIN CONDITIONS Wynzora 0.005%-0.064% Cream betamethasone dipropionate, calcipotriene-betamethasone dipropionate, clobetasol propionate, diflorasone diacetate, calcipotriene (generic), Enstilar

URINARY TRACT CONDITIONS Vesicare LS 5 MG/5 ML supension oxybutynin, oxybutynin ER

March 12, 2021 PAIN RELIEF AND INFLAMMATORY DISEASE Qdolo 5 MG/ML Solution tramadol (generic tablet)


GASTROINTESTINAL/HEARTBURN Sutab 1.479-0.225-0.188 GM tab Gavilyte-G, peg-electrolyte solution, peg-3350, Trilyte with Flavor packets.

SKIN CONDITIONS Winlevi 1% cream clindamycin topical, clindamycin-tretionin, erythromycin topical, tretinoin, Amzeeq, Onexton

February 5, 2021 EYE CONDITIONS Eysuvis 0.25% Eye Drops loteprednol etabonate, artificial tears

Medications moving to a higher cost-share tier

New cost-share tier Generic and/or preferred brand alternatives

Descovy T4 emtricitabine/tenofovir disoproxil fumarate 200mg-300mg (generic Truvada)

vancomycin capsule T4 FirvanqMedications that will need approval (prior authorization)


capecitabine Your patient can only receive this medication if you request and receive approval from Cigna.

deferasirox

Descovy

Nuedexta

penicillamine

teriparatide 620mcg/2.48ml (generic Forteo)

tobramycin 300mg/5ml inhalation

Vascepa

Drug lists used by patients who purchase their own health plan

CIGNA ESSENTIAL PRESCRIPTION DRUG LIST (for Colorado and Utah)

Medications being added to the Step Therapy program


Xeljanz XR1 Humira (needs approval)

Xeljanz1


Medications that will no longer be covered Generic and/or preferred brand alternatives

Afinitor Tablet everolimus tablet

alogliptin Onglyza

alogliptin/metformin Kombiglyze XR

alogliptin/pioglitazone Kombiglyze XR

Apriso ER mesalamine

Atripla efavirenz/emtricitabine/tenofovir df

Cuprimine penicillamine

Depen penicillamine

Exjade deferasirox

Firazyr icatibant

Forteo teriparatide

Glucagen Gvoke

Glucagon Gvoke

Jadenu Sprinkle & Tablet deferasirox

Letairis ambrisentan

Levocarnitine IV levocarnitine solution or tablet

Lyrica pregabalin

Moxeza moxifloxacin hcl

Prudoxin doxepin 5% cream



Samsca tolvaptan

Saphris asenapine maleate

Sensipar cinacalcet

Tarceva erlotinib hcl

Tracleer 62.5mg & 125mg bosentan

Truvada 200mg-300mg emtricitabine/tenofovir disoproxil fumarate 200mg-300mg (generic Truvada)

Tykerb lapatinib ditosylate

Zortress everolimus

CIGNA ESSENTIAL PRESCRIPTION DRUG LIST (for Colorado and Utah) cont.

Medications that will be excluded from coverage Additional information

Iodosorb Gel Talk with your patient about switching to a covered alternative.

Lugol's Strong Iodine Solution



vancomycin capsule T4 Firvanq


CIGNA PLUS PRESCRIPTION DRUG LIST (for Illinois, Kansas, Missouri, North Carolina and Tennessee)

Medications that will need approval (prior authorization)


capecitabine Your patient can only receive this medication if you request and receive approval from Cigna.deferasirox

Descovy

Ferriprox

Fycompa

Nuedexta

penicillamine



trientine

Vascepa




Xeljanz1


CIGNA PLUS PRESCRIPTION DRUG LIST (for Illinois, Kansas, Missouri, North Carolina and Tennessee) cont.



alogliptin Onglyza





Carnitor SF Oral Solution levocarnitine sf oral solution


Depen penicillamine

Dyrenium triamterene

Exjade deferasirox

Firazyr icatibant

Forteo teriparatide

Glucagen Gvoke

Glucagon Gvoke

Halog 0.1% Cream halcinonide




Lotemax 0.5% Eye Drops loteprednol etabonate 0.5% eye drops

Lyrica pregabalin


Naftin 1% Gel naftifine hcl 1% gel

Nascobal cyanocobalamin inj

Noxafil DR 100mg Tablet posaconazole 100mg tablet


Restasis cyclosporine eye drops

Samsca tolvaptan


Sensipar cinacalcet

Suprax 400mg Capsule cefixime 400mg capsule





Uloric febuxostat


CIGNA PLUS PRESCRIPTION DRUG LIST (for Illinois, Kansas, Missouri, North Carolina and Tennessee) cont.


Velphoro sucroferric oxyhydroxide

Zortress everolimus




CIGNA PLUS PRESCRIPTION DRUG LIST (for Florida)







Descovy

Ferriprox

Fycompa

Nuedexta Your patient can only receive this medication if you request and receive approval from Cigna.penicillamine



trientine

Truvada 200mg-300mg

Vascepa




Xeljanz1



alogliptin Onglyza






CIGNA PLUS PRESCRIPTION DRUG LIST (for Florida) cont.



Depen penicillamine


Exjade deferasirox

Firazyr icatibant

Forteo teriparatide

Glucagen Gvoke

Glucagon Gvoke






Lyrica pregabalin







Samsca tolvaptan


Sensipar cinacalcet





Uloric febuxostat


Zortress everolimus





CIGNA PREMIERE PRESCRIPTION DRUG LIST (for Arizona and Virginia)








Descovy

Ferriprox

Fycompa

Nuedexta

penicillamine



trientine

Vascepa




Xeljanz1



alogliptin Onglyza







Depen penicillamine


Exjade deferasirox

Firazyr icatibant

Forteo teriparatide

Glucagen Gvoke

Glucagon Gvoke




CIGNA PREMIERE PRESCRIPTION DRUG LIST (for Arizona and Virginia) cont.





Lyrica pregabalin







Samsca tolvaptan


Sensipar cinacalcet






Uloric febuxostat


Zortress everolimus




* State laws in Texas and Louisiana may require your plan to cover these medications at the current benefit level until your plan renews. This means that if the medication is taken off the drug list, is moved to a higher cost-share tier or needs approval from Cigna before your plan will cover it, these changes may not begin until your plan’s renewal date. Customers can call the number on their Cigna ID card to find out if these state laws apply to your plan.

** State law in Illinois may require your plan to cover these medications at your current benefit level until your plan renews. This means that if customers currently have prior authorization for your plan to cover the medication, the drug list change(s) listed here may not affect them until your plan renewal date. If customers do not currently have prior authorization, they may continue to receive coverage at the current benefit level if their doctor requests it. Customers can call the number on their Cigna ID card to find out if this state law applies to your plan.

1. This is a specialty drug. For plans that cover specialty drugs on a specialty tier, this change won’t affect its cost.

2. If your plan has Member Pay Difference (MPD), the MPD penalty will apply to this drug as of 1/1/21. However, if your plan allows for Dispense as Written (DAW) and the doctor requests the brand, the penalty won’t apply.

3. These changes may not apply to your specific plan. Not all plans include requirements for prior authorization, quantity limits and/or Step Therapy.

4. For new prescriptions only. This change won’t affect customers currently taking this drug.

5. Current authorizations will expire 1/1/21. There is a “medical necessity” review process in place for customers who want to continue using this drug.

6. There is a “medical necessity” review process in place for customers who have proven they have exhausted drug alternatives and want to use a drug moving to not-covered status.

7. If Cigna approves continued coverage of this drug, the customer will pay a higher cost-share to fill the prescription.

8. This drug will no longer part of Step Therapy as of 1/1/21. Current authorizations will expire 1/1/21. There is a “medical necessity” review process in place for customers who want to continue using this drug. However, if Cigna approves continued coverage, the customer will pay a higher cost-share to fill the prescription.

9. This drug will no longer part of Step Therapy as of 1/1/21. Current authorizations will expire 1/1/21. There is a “medical necessity” review process in place for customers who want to continue using this drug.

10. Current authorizations will expire 1/1/21. There is a “medical necessity” review process in place for customers who want to continue using this drug. However, if Cigna approves continued coverage, the customer will pay a higher cost-share to fill the prescription.

11. This change doesn’t affect customers currently taking this drug to treat a seizure condition. Current authorizations will expire 1/1/21. There is a “medical necessity” review process in place for customers who want to continue using this drug.

12. If Cigna approves continued coverage of this drug, the customer will pay a higher cost-share to fill the prescription. This drug may also be subject to a MPD penalty.

13. This change won’t affect customers currently taking this drug until their current authorization expires.

14. This drug also requires prior authorization as of 1/1/21.

15. This drug will be part of Step Therapy as of 1/1/21. Current authorizations will expire 1/1/21. There is a “medical necessity” review process in place for customers who want to continue using this drug.

16. There is a “medical necessity” review process in place for customers who have proven they have exhausted drug alternatives and want to use a Step Therapy drug.

Cigna reserves the right to make changes to the 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 doctor or pharmacist. Cigna may receive payments from manufacturers of certain preferred brand medications, and in limited instances, certain non-preferred brand medications, that 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. Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. If your plan provides coverage for certain prescription drugs with no cost-share, you may be required to use an in-network pharmacy to fill the prescription. If you use a pharmacy that does not participate in your plan’s network, your prescription may not be covered, or reimbursement may be limited by your plan’s copayment, coinsurance or deductible requirements. Certain features described in this document may not be applicable to your specific health plan, and plan features may vary by location and plan type. Refer to your plan documents for costs and complete details of your plan’s prescription drug coverage.

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, and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

951714 © 2021 Cigna. Some content provided under license. CRP2012_007122.1 UPDATED_05/21/2021

prescription drug list changes - cigna...nutritional/dietary pregenna, trinaz any generic prenatal...

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