member’s additional information (v4)all cigna products and services are provided exclusively by or...
TRANSCRIPT
The Self-Funded Program provides tools for small-business employers to establish a self-funded health benefit plan for their employees. The benefit plan is established by the employer and is not an insurance product. Stop-loss insurance for the National General Benefits Solutions
Self-Funded Program is underwritten and issued by Time Insurance Company, National Health Insurance Company, Integon National Insurance Company, and Integon Indemnity Corporation.
(9/2016) © 2016 National Health Insurance Company. All rights reserved. 20161201.v4.1
MEMBER’SADDITIONAL INFORMATION (V4)� ASA�EMPLOYEE�ASSISTANCE�PROGRAM�(AETNA)�
� CIGNA�(PHARMACY�BENEFIT�MANAGER):�
� CIGNA�WELCOME�LETTER�
� FIVE�WAYS�TO�SAVE�
� CLICK�WITH�A�SITE�THAT�CLICKS�WITH�YOU�
� PAYER�SOLUTIONS:�� PHARMACY�� GENERIC�MEDICATION�
� 90�NOWSM�(90�DAY�PRESCRIPTIONS)�
� RETAIL�PHARMACY�DIRECTORY�(90�DAY�NETWORK�PHARMACY�DIRECTORY)�
� HOME�DELIVERY�PHARMACY�
� STEP�THERAPY�
� PHARMACY�ADVANTAGE�PRESCRIPTION�DRUG�LIST�
� SPECIALTY�PHARMACY�DRUG�LIST�
� PRESCRIPTION�DRUG�CLAIM�FORM�
� HOME�DELIVERY�ORDER�FORM�
� PHARMACY�CHAIN�LISTING�BY�STATE�
� ALLIED:�SAMPLE�EOB�(EXPLANATION�OF�BENEFITS)�
A website built for youAetna Resources For LivingSM
Get information and advice on the things that matter to you
Your member website is a single source for information on your career, health and personal life. With just a couple clicks, you can:
��Search for child or elder care providers��Learn about health conditions��Take well-being assessments��Access self-help tools and information
Find discounts on over 3 million products and services
The online discount service features savings on brand-name products and services like:
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Access myStrength — the health club for your mind
myStrength is an easy-to-use online/mobile self-help resource for depression and anxiety.
��Daily tips for your mind, body and spirit��Built and customized for each user��Based on the latest clinical research and
professional advice from best-selling authors��Packed with resources to improve mental health
Check out your member website today.
Check out these Employee Assistance Program (EAP) web tools and resources now available to your members.
www.mylifevalues.comUsername: peaceofmind / Password: solutions
Aetna Resources For LivingSM is the brand name used for products and services offered through the Aetna group of subsidiary companies. The EAP is administered by Aetna Behavioral Health, LLC. In California for Knox-Keene plans, Aetna Health of California, Inc. and Health and Human Resources Center, Inc.All EAP calls are confidential, except as required by law. This material is for informational purposes only. It contains only a partial, general description of programs and services and does not constitute a contract. EAP instructors, educators and network participating providers are independent contractors and are neither agents nor employees of Aetna. Aetna does not direct, manage, oversee or control the individual services provided by these persons and does not assume any responsibility or liability for the services they provide and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. ������ ����������������� ���� � ������������������ ����!������������"������ ��#��������������� ���� ������ ��� ����refer to www.aetna.com.
©2014 Aetna Inc. 44.03.508.1-ASA (10/14)
myStrengthTM: the health club for your mindAetna Resources For LivingSM
Strengthen your whole self
myStrength offers tools to improve your emotional health and help you overcome depression, anxiety or substance abuse. Once you get set up with myStrength, you’ll log on to a home page created just for you.
myStrength is:
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You can read articles, watch videos and try eLearning programs. Or you can just get inspired by the daily quote.
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Give the app a try, too
You can get inspired on the go. With the myStrength app you can:
�� Get custom inspiration based on your mood
��Track your mood over time
��Upload your own inspiring photos and videos
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Easy sign-up
You can register for myStrength from the link on your member website.
Now you’re ready to start exploring all that myStrength has to offer.
“myStrength.com is a great wellness tool for your mind, body and spirit! I love the daily inspirational quotes and wellness articles. [It’s] a great way for me to proactively take care of myself.”
— myStrength user
Aetna Resources For LivingSM is the brand name used for products and services offered through the Aetna group of subsidiary companies. The EAP is administered by Aetna Behavioral Health, LLC. In California for Knox-Keene plans, Aetna Health of California, Inc. and Health and Human Resources Center, Inc.����+�G�� ���� ���������� ���Q��� ���R������$�� !#������� �� ��������������� ��� �������������$#������� ���������� ��������������������� ��� ���� �� ���������� ������� ���� ��������� ���� ����������� ��#���� �� �� ���� ����������� ��!��� �$�questions or concerns about specific health care needs. This material is for informational purposes only. It contains only a partial, general ������������������ ��� ���������� ����������������� ����� �#�+�G��������������� ���� ����!��K�� ����� ������������� �� ������������ ����� ��� ������� ������������$������� #��� ��������������� � ������������������ ��individual services provided by these persons and does not assume any responsibility or liability for the services they provide and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. ������ ����������������� ���� � ������������������ ����!������������"������ ��#��������������� ���� ������ ��� ����refer to www.aetna.com.
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www.mylifevalues.comUsername: peaceofmind Password: solutions
Cigna Corporation 900 Cottage Grove Road Bloomfield, CT 06002
Welcome to Cigna Payer Solutions Pharmacy Program to manage your prescription drug plan. This program is administered through Cigna Pharmacy Management.
There are several benefits offered to you as part of the Cigna Payer Solutions Pharmacy Program. We support you to get the most out of your pharmacy benefit plan with personalized service to help you:
1. Learn what drugs are covered: Save money by checking out the covered drug list onmyCigna.com. The amount you pay depends on whether your medication is listed as a generic, preferred brand or non-preferred brand drug.
2. Compare prices: Use the Prescription Drug Price Quote Tool to see what drugs cost with your plan. You can also compare prices at over 68,000 retail pharmacies and Cigna Home Delivery PharmacySM. It’s all part of the pharmacy page on myCigna.com.
3. Go generic: Request the generic from your doctor. Generic medications have the same strength and active ingredients as their brand-name counterparts. They are sold under the chemical or scientific name of the medication instead of the manufacturer’s patented brand name. If you are prescribed a brand-name medication and a generic is available, whether prescribed by your doctor or you request it at the pharmacy, the cost difference between the brand and generic medications will be your responsibility.
4. Fill a 90-day supply for increased convenience: Use Cigna Home Delivery Pharmacy and have your maintenance medication delivered right to your door at no additional cost. Beginning January 1, 2017, the Cigna 90 Now network will also allow you to fill 90 days of your maintenance medications at 29,000 retail pharmacies nationwide. To find a participating 90-day pharmacy, go tomyCigna.com or call Cigna Customer Service.
5. Specialty pharmacy medications: Take advantage of TheraCare®, our chronic condition support service for customers who use injectable medications for conditions like multiplesclerosis, hepatitis C, and hemophilia. Certain specialty medications are required to be filled at Cigna Home Delivery; to see if your medication is one of them go to myCigna.com or call Cigna Customer Service.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
09/16 © 2016 Cigna. Some content provided under license.
6. Use the pharmacy page of myCigna.com: You have 24/7/365 access to your pharmacy claim history, benefit details, recent industry and Cigna news and a comparison of drug and pharmacy prices. You are also able to manage your Cigna Home Delivery Pharmacy orders and ask a pharmacist a question.
You will receive your new ID card in a separate mailing. Please remember to show this card at your pharmacy in order to receive your prescription benefits. If you have any questions about your prescription benefits or would like more information, please feel free to call Cigna Payer Solutions at 1-800-325-1404 or visit myCigna.com.
Welcome to Cigna Payer Solutions, we look forward to serving you.
Sincerely,
Amie L. BenedictPresident and General Manager, Cigna Payer Solutions
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Tel-Drug, Inc., and Tel-Drug of Pennsylvania, L.L.C. “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
887776 03/16 © 2016 Cigna. Some content provided under license.
Questions? Call the toll-free number on the back of your ID card.
Cigna Payer SolutionsCigna Payer Solutions
1. Learn what medications are covered
Save money by checking out the list of medications covered under your plan on myCigna.com. The amount you pay depends on whether your medication is listed as a generic, preferred brand, non-preferred brand or specialty medication.
2. Use the Prescription Drug Price Quote tool
View medication cost based on your pharmacy plan, see if there are lower cost alternatives and compare prices between Cigna Home Delivery PharmacySM and retail pharmacies.
3. Use Cigna Home Delivery PharmacySM
Have the medications you take on a daily basis delivered right to your door at no additional cost. Because you can get up to a 90-day supply at one time, you may even be able to save money. You’ll get a reminder when it’s time to reorder, and have access to the CoachRx team for help with drug interactions, side effects and ways to lower your medication costs.
4. Get help with specialty medications
Take advantage of TheraCare®. Your personalized team will help you better understand your chronic condition (like multiple sclerosis, hepatitis C or hemophilia) and medication, including common side effects and how to follow your doctor’s treatment instructions correctly.
5. Use myCigna.com
Gives you 24/7/365 access to:
› See your pharmacy claim history
› Read your benefit details
› See medication prices based on your plan
› Manage your Cigna Home Delivery Pharmacy orders
› Ask a pharmacist a question
YOUR PHARMACY BENEFITS
Five ways to get the most out of your pharmacy benefit plan
CLICK WITH A SITE THAT CLICKS WITH YOU
myCigna.com
Offered by: Cigna Health and Life Insurance Company.
885468 09/15 Cigna Payer Solutions
We’ve made myCigna.com all about you
Log in and you’ll find the information you need to manage your health and access your pharmacy coverage, including powerful tools, information and resources to help you make informed health care decisions. The site is designed to make it easier to quickly find exactly what you’re looking for, and it’s compatible with your mobile device – so you can find whatever you need, whenever you need it.
Get started
Go to myCigna.com. The first time you visit, you will be directed through a simple registration process. Once you’ve registered, keep your User ID and password in a safe place and bookmark myCigna.com for future use.
When you log in to myCigna.com, everything you need to manage your health and health care expenses is just a few clicks away.
Get informed
Now you’re ready to take advantage of myCigna.com and its many health and pharmacy-related features.
As soon as you’re on myCigna.com, you’ll see it’s all about you – your pharmacy coverage and claim information, plus tools and resources to improve your health and wellness. You can also easily find a doctor in your network.
The first time you visit myCigna.com, you’ll be directed through a simple registration process.
Cigna Payer Solutions
*Quality designations and cost-efficiency ratings reflect a partial assessment of quality and should not be the sole basis for decision-making (as such measures have a risk of error). They are not a guarantee of the quality of care that will be provided to individual patients. Individuals are encouraged to consider all relevant factors and consult with their physician when selecting a health care professional or facility for care. Health care professionals and facilities that participate in the Cigna network are independent contractors solely responsible for the treatment provided to their patients. They are not agents of Cigna.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Tel-Drug, Inc., and Tel-Drug of Pennsylvania, L.L.C. “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
885468 09/15 Cigna Payer Solutions © 2015 Cigna. Some content provided under license.
Cigna Care Designation
Quality Designations
Specialty: Pediatrics
C
It’s your health. And myCigna.com is your site.
You’ll find helpful resources on a variety of health-related topics under your “Manage My Health” section.
See your pharmacy coverage
Your pharmacy coverage details are all in one easy-to-access place. View all your current claims information, including when and where you received services, what you were billed for and what you paid. See your benefits booklet for specific eligibility and coverage information.
Use your tools
When you have more information, you’ll feel better about your health and your health spending. That’s why we have tools to help you calculate costs, compare plan costs, estimate treatment costs and more.
› Drug price quote tool – look up prescriptions to compare prices. We also suggest lower-cost alternatives like home delivery or generics.
› Pharmacy home delivery – you can learn more about Cigna Home Delivery PharmacySM and order refills of your prescriptions.
› Medical cost estimator – compare estimated costs for various procedures based on Cigna’s historical cost data.
› Manage your health – the “Manage My Health” section includes a wealth of tools and information to help you get healthy and stay healthy. You’ll find articles, support groups and other resources on a variety of topics, including blood pressure, cholesterol, tobacco cessation, weight management, stress and more.
Find a health care professional or pharmacy
Search for your doctor by name or search our network for a specific type of doctor, pharmacy or medical facility. You can filter your results by distance, cost efficiency, specialty and more – even by whether they are accepting new patients. You can also email a copy of your search results.
Be sure to look for the Cigna Care Designation symbol – which identifies doctors who have met certain Cigna quality and cost-efficiency measures.*
Offered by: Cigna Health and Life Insurance Company
892878 a 08/16 Cigna Payer Solutions
CHOICE. AFFORDABILITY. EXPERTISE.
Cigna Pharmacy Management®
Available through select Third Party Administrators (TPAs), Cigna Pharmacy Management delivers innovative products coupled with pharmacy expertise – to help TPAs and employers design plans that drive value and improved clinical outcomes. Cigna offers: competitive networks and clear pricing; broad choice to drive lower costs; effective clinical programs; excellent service for clients and members, and a deep understanding of the Pharmacy Benefit Management (PBM) marketplace. Together, we focus on improved outcomes to help members achieve better health. We know helping members improve their health is a sustainable way to reduce total health care spending.
Cigna Payer Solutions
Excellent service for clients and members
Cigna Payer Solutions offers a customer-centric approach for both clients and members. For our preferred TPAs, that means a single point of contact for Pharmacy Benefit Management issue resolution and operational questions.
For members – it’s an integrated, personalized, and compassionate approach to member service – 24/7. That includes:
› 24/7/365 live customer service
› The myCigna.com member portal and myCigna mobile app for personalized cost and benefit information at work, at home, or on-the-go
› 24/7 access to Cigna Home Delivery PharmacySM pharmacists
› No jargon
› Transition assistance to Cigna Home Delivery Pharmacy
Competitive networks and clear pricing
Cigna Payer Solutions’ Pharmacy Benefit Management offers three ways to help employers lower pharmacy costs:
› Our competitive and broad national network offers discounts that are in line with leading competitors, and access to 68,000 pharmacies nationwide, including a 90-day retail network of 29,000 pharmacies for even greater savings.1
› Key services are included in pricing – no additional charge for clinical programs such as narcotic therapy management, specialty pharmacy, step therapy, personalized mailings to members and more.
› Additional incentives for bundling PBM with the Cigna PPO medical network.
Broad choice to drive lower costs
› Plan design flexibility to provide appropriate product coverage and cost share and promote preventive drugs
› Two formulary options
› In addition to Cigna’s large national network, we offer the choice of a limited 90-day retail network as well as three narrow network options
› Three tier drug plan recommended
Effective clinical programsOur clinical pharmacy programs help ensure appropriate utilization of medications, promote preventive drugs, help improve health, and reduce total healthcare spending. Cigna Pharmacy Benefit Management is cost-effective and flexible, and offers a wide choice of clinical programs to help members get more value for their benefit dollar – at no additional cost.
Improved medication adherence with CoachRx
Cigna Pharmacy’s CoachRx program encourages members to understand their likelihood of becoming non-adherent and provides tools to keep adherence from becoming a challenge. The program offers daily reminders, free pill boxes, and educational materials.
Alert members to savings opportunities with Rx Savings Messenger
Rx Savings Messenger generates personalized mailings to members educating them about ways they can save – showing actual savings potential on currently prescribed medications by exploring generic medications.
Step Therapy promotes lower-cost therapies with personalized outreach
Cigna Pharmacy’s Step Therapy program promotes the use of generic drugs and lower-cost, brand-name alternatives, while at the same time avoiding disruption for the member at the pharmacy and providing members and their physicians the flexibility to use brand-name drugs when medically necessary.
Utilization management through Prior Authorization
Prior authorization helps control rising costs by requiring that certain high-cost medications undergo a review for medical necessity before being prescribed. Cigna Pharmacy also incorporates drug utilization review to identify potentially adverse drug restrictions and possible prescription errors and quantity level limits to help ensure members receive only the necessary quantity of medication.
90-Day Refills for Maintenance Medications
Members who take medications on a regular basis can enjoy the convenience of 90-day refills, either at 29,000 national retail locations or delivered directly to their home via Cigna Home Delivery Pharmacy. Members who fill 90-day prescriptions have a 41% higher adherence rate than those who fill 30-day prescriptions.2 And, clients have the option to help reduce costs even more by requiring 90-day fills for maintenance medications.
Identify potential inappropriate use with Narcotic Therapy Management
Narcotic Therapy Management identifies unusual and potentially inappropriate use patterns and offers physicians comprehensive clinical information to create an integrated view of the member’s overall treatment, including conditions and prescription use. In a study, members receiving intervention reduced narcotic prescription use by 40%, and combined medical and pharmacy costs were reduced by an average of $2,200, or 34%.3
Specialty drugs require a complete management strategy
According to a recent IMS study, by 2020, specialty drugs will represent just 2% of all prescribed drugs, but 30% of all drug costs.4 Cigna Specialty Pharmacy ManagementSM offers a comprehensive program for individuals who require specialty drugs to treat rare and chronic diseases – focusing on adherence, support and lower unit cost. Through clinical review of medications, therapy management, and health advocacy programs, we help manage costs and improve health outcomes. We also recommend a 30-day supply limit on specialty medications to help reduce waste and control costs.
Added support for members with specialty conditions – TheraCare
For members who use specialty medications to manage chronic conditions, Cigna Pharmacy’s TheraCare® program helps them better understand their conditions, medications, and side effects, and increase their understanding of the importance of taking medications exactly as prescribed – with a focus on total health.
1. Cigna National Book of Business as of 12/31/2015. Actual number will vary.2. Internal Cigna analysis performed March 2016, utilizing 2015 Cigna national book of business average medication adherence
(customer adherent > 80% proportion of days covered (PDC)), 90-day supply vs. those who received a 30-day supply taking antidiabetics, renin-angiotensin system (RAS) antagonist and statins. Individual client results will vary and savings are not guaranteed.
3. For members receiving intervention. Source: Cigna analysis of 5,758 individuals with interventions and continuously enrolled during the 3-month pre-intervention, 3-month intervention and 3-month post intervention periods between 3rd Quarter 2012 and 2nd Quarter 2013.
4. “Global Medicines Use in 2020: Outlook and Implications.” IMS Institute for Healthcare Informatics. Published November 18, 2015.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna Health Management, Inc., Tel-Drug, Inc., and Tel-Drug of Pennsylvania, L.L.C. “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc..
892878 a 08/16 Cigna Payer Solutions © 2016 Cigna. Some content provided under license.
What is a generic medication?
Generic medications have the same strength and active ingredients as their brand-name counterparts. They are sold under the chemical or scientific name of the medication instead of the manufacturer’s patented brand name. Brand-name medications have patents that last for twenty years, protecting the rights of the owner and sole manufacturer. Once the patent expires, other manufacturers are free to make the medication in a generic form.
What are the differences between brand-name medications and their generic alternatives?
Generic medications may differ from their brand-name counterparts in shape, packaging, color, flavor, preservatives, expiration time and, sometimes, labeling. The U.S. Food and Drug Administration (FDA) requires that all medications, both brand name and generic, meet the same requirements for quality, strength, purity and potency. The FDA only approves generic medications that have the same active ingredients and work the same way in the body as their brand-name counterparts.
877777 12/15
Common brand-name medications with generic equivalents
BRAND NAME GENERIC NAME COMMON USE
Cozaar/Hyzaar losartan/losartan-hctz
High blood pressureDiovan/Diovan HCT valsartan/valsartan-hctz
Toprol XL metoprolol ER
Lipitor atorvastatinHigh cholesterol
Zocor simvastatin
Fosamax alendronate Osteoporosis
Lexapro escitalopram Depression
Zoloft sertraline
Prilosec omeprazoleHeartburn//ulcer (acid reflux)
Protonix pantoprazole
Cigna Payer SolutionsCigna Payer Solutions
ANSWERING YOUR QUESTIONS ABOUT GENERIC MEDICATIONS
Helpful information
Do generics take longer to work?
No. When a manufacturer wants to make a generic medication, they must prove to the FDA that the medications works the same way in the body and within the same amount of time as the brand-name medication.
Are generics as safe as brand-name medications?
The manufacturer of the generic medication must prove to the FDA that the generic medication is as safe as its brand-name counterpart.
Why should I choose a generic medication?
Generic medications usually cost 80%–85% less than their brand-name counterparts.* So, generic medications may save you money.
How do I choose a generic medication?
You should talk with your doctor to see if a generic medication will work for you. Also, you can use the Drug Price Quote tool on myCigna.com to find out what medications cost under your pharmacy plan, and compare prices between Cigna Home Delivery PharmacySM and retail pharmacies.
Generic medications usually cost 80%–85% less than their brand-name counterparts.*
* Facts about Generic Drugs, U.S. Food and Drug Administration, U.S. Department of Health & Human Services. (http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingGenericDrugs/ucm167991.htm)
The information provided here is intended to be general information on how you can get the most out of your prescription drug plan. It is not intended as medical advice. You are encouraged to consider all relevant factors and to consult with your doctor for care and treatment advice. The drugs listed in this document may not be covered under your plan. Review your employer’s prescription drug list for a listing of the medications that are covered under your specific plan. 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 copay, coinsurance or deductible requirements. 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. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
877777 12/15 © 2015 Cigna. Some content provided under license.
You have a lot going on. Taking your medication every day and remembering to pick up your refill every month isn’t always easy. We have a program that can help – it’s called Cigna 90 Now.
90-DAY PRESCRIPTION FILLSFilling your maintenance medications just got easier with Cigna 90 NowSM
More choice
Your plan includes a new maintenance medication program called Cigna 90 Now. Maintenance medications are taken regularly, over time, to treat an ongoing health condition. Cigna 90 Now offers you more choice in how, and where, you can fill your prescription.
Choose what works best for you
› If you choose to fill your prescription in a 90-day supply, you have to use a 90-day retail pharmacy in your plan’s new network, or Cigna Home Delivery PharmacySM.*
› If you choose to fill your prescription in a 30-day supply, you can use any pharmacy in your plan’s new network, including Cigna Home Delivery Pharmacy.
Where you can fill a 90-day prescription
With Cigna 90 Now, your plan offers a new retail pharmacy network that gives you more choice in where you can fill your 90-day prescriptions.
There are thousands of retail pharmacies in your new network. They include local pharmacies, grocery stores, retail chains and wholesale warehouse stores – all places where you may already shop! If you prefer the convenience of having your medications delivered to your home, you can also use Cigna Home Delivery Pharmacy to fill your prescriptions.*
For more information about your new pharmacy network, you can go to Cigna.com/Rx90network.
Why fill a 90-day supply?
Filling your prescriptions in a 90-day supply may help you stay healthy because having a 90-day supply of your medication on-hand typically means you’re less likely to miss a dose.** It also means you can make fewer visits to the pharmacy to refill your medication, and depending on your plan, you may be able to save money by filling your prescriptions 90-days at a time.
You choose! 90-day or 30-day supply.
Here are some of the 90-day retail pharmacies in your network:***
› CVS (including Target and Navarro)
› Walmart
› Kroger (including Harris Teeter Pharmacy, Pick N Save Pharmacy, Fred Meyer Pharmacy, Fry’s Food and Drug)
› Access Health (including Benzer Pharmacy, Marcs, Big Y Pharmacy, Marsh Drugs, LLC, Snyder Drug Emporium)
› Good Neighbor Pharmacies (including Big Y Pharmacy, Super RX Pharmacy, Medical Center Pharmacy, Family Pharmacy, King Kullen Pharmacy)
› Cardinal Health (including Freds Pharmacy, Medicine Shoppe Pharmacy, Harris Teeter Pharmacy, Medicap Pharmacy)
893345 b VoluntaryCigna90Now 08/16
90-Day Fills
Prefer to have your medications delivered to your door?
Then Cigna Home Delivery Pharmacy may be right for you! We’ll deliver your maintenance medication to you at the location of your choice. And standard shipping is always free. No more waiting in line at the pharmacy! For more information, please call Customer Service at 800.285.4812, or visit Cigna.com/home-delivery-pharmacy.
Get a 90-day prescription for your medication
Get a 30-day prescription for your maintenance medication
Take your prescription to a 90-day retail pharmacy in your network,
or mail to Cigna Home Delivery Pharmacy
Take your prescription to any retail pharmacy in your network, or mail to Cigna Home Delivery Pharmacy
Receive your medication in a 90-day supply for
convenience
Receive your medication
30-Day Fills
* Plans vary, so some plans may not include Cigna Home Delivery Pharmacy. Please check your plan materials for more information on what pharmacies are covered under your plan.
** Internal Cigna analysis performed March 2016, utilizing 2015 Cigna national book of business average medication adherence (customer adherent > 80% PDC), 90-day supply vs. those who received a 30-day supply taking antidiabetics, RAS antagonist and statins.
*** Participating 90-day network pharmacies as of April 2016. Subject to change.
Para obtener ayuda en español llame al número en su tarjeta de Cigna.
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. 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, Cigna Health Management, Inc., Tel-Drug, Inc., and Tel-Drug of Pennsylvania, L.L.C. “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
893345 b VoluntaryCigna90Now 08/16 © 2016 Cigna. Some content provided under license.
Questions?
Please call Customer Service at 800.Cigna 24 (800.244.6224). We’re here to help.
Offered by: Cigna Health and Life Insurance Company or Connecticut General Life Insurance Company.
893348 Cigna90Now 10/16
CIGNA 90 NOW
RETAIL PHARMACY DIRECTORY
For customers who must use a 90-day network pharmacy to fill their 90-day prescriptions
Filling your maintenance medications just got easier with Cigna 90 Now
With Cigna 90 NowSM, your plan offers a retail pharmacy network that gives you more choice in where you can fill your prescriptions for the medications you take every day. There are thousands of retail pharmacies in your network. They include local pharmacies, grocery stores, retail chains and wholesale warehouse stores – all places where you may already shop!
Under your plan, 90-day prescriptions have to be filled at one of the 90-day retail pharmacies in your network, or Cigna Home Delivery PharmacySM, to be covered.1
Where you can fill your prescriptions
The following is a list of the largest retail pharmacy chains in the United States that participate in your network. In addition to the chains listed, Cigna has contracted with a number of independent retail pharmacies in each state. Every pharmacy in your network can fill a 30-day prescription, and a select number of pharmacies can fill a 90-day prescription. Pharmacies that can fill a 90-day prescription will have this symbol next to them. To see a complete list of retail pharmacies in your network, go to Cigna.com/Rx90network.
Medications delivered to your door
Cigna Home Delivery Pharmacy will deliver your maintenance medication to you at the location of your choice. And standard shipping is always free. For more information, please call customer service at 800.285.4812, or visit Cigna.com/home-delivery-pharmacy.
Questions?
Please call customer service using the number on the back of your Cigna ID card. We’re here to help.
You can also visit Cigna.com/Rx90network for more information about your network.
PHARMACY DIRECTORY
Acme Pharmacy
Aurora Pharmacy
Bartell Drugs
Benzer Pharmacy
Big Y Pharmacy
Bi Lo Pharmacy
Bi-Mart Pharmacy
Brookshire Brothers Pharmacy
Brookshires Pharmacy
Community Pharmacy
Costco Pharmacy
Cub Pharmacy
CVS Pharmacy (includes Target)
Dillon Pharmacy
Discount Drug
Dod
Duane Reade
Family Pharmacy
Farmacia
Food City Pharmacy
Fred Meyer Pharmacy
Fred’s Pharmacy
Freds Pharmacy
Fry’s Food And Drug
Genoa, A Qol Healthcare
Giant Pharmacy
Giant Eagle Pharmacy
Hannaford Food And Drug
Harris Teeter Pharmacy
Heb Pharmacy
Hometown Pharmacy
Hy-Vee Pharmacy
Ingles Pharmacy
King Kullen Pharmacy
King Soopers Pharmacy
Kinney Drugs
KMart Pharmacy
Kroger Pharmacy
Longs Drugs
Marcs
Marsh Drugs, LLC
Martin’s Pharmacy
Medical Center Pharmacy
Medicap Pharmacy
The Medicine Shoppe Pharmacy
Meijer Pharmacy
Navarro Discount Pharmacy
Omnicare
Osco Drug
Osco Pharmacy
PharMerica
Pick N Save Pharmacy
Price Chopper Pharmacy
Publix Pharmacy
Raleys Pharmacy
Ralphs Pharmacy
Rite Aid Pharmacy
Safeway Pharmacy
Sams Pharmacy
Savon Pharmacy
Schnucks Pharmacy
Shopko Pharmacy
ShopRite Pharmacy
Smiths Pharmacy
Snyder Drug Emporium
Stop & Shop Pharmacy
Super RX Pharmacy
Tom Thumb Pharmacy
Tops Pharmacy
Vons Pharmacy
Walgreens
Walmart Pharmacy
Wegmans Food Market Inc.
Weis Pharmacy
Winn Dixie
Pharmacies with this symbol next to them can fill 30-day or 90-day prescriptions. Pharmacies without that symbol can only fill up to a 30-day supply. Call your local retail pharmacy to make sure they can fill your prescription in a 90-day supply.
Para obtener ayuda en español llame al número en su tarjeta de Cigna.
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. 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, Cigna Health Management, Inc., Tel-Drug, Inc., and Tel-Drug of Pennsylvania, L.L.C. “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures used for illustrative purposes only.
893348 Cigna90Now 10/16 © 2016 Cigna. Some content provided under license.
Cigna 90 Now FAQsWhat’s Cigna 90 Now?
› It’s a maintenance medication program that includes a 90-day retail benefit and pharmacy network. Maintenance medications are taken every day to treat an ongoing health condition. If you fill your prescription in a 90-day supply, you have to use a 90-day retail pharmacy in your plan’s network or Cigna Home Delivery Pharmacy.1
What kinds of prescriptions are best filled in a 90-day supply?
› Maintenance medications. These are taken regularly, over time, to treat an ongoing health condition, such as diabetes, high blood pressure, cholesterol or asthma.
› With Cigna 90 Now, you can’t fill narcotics and specialty medications in a 90-day supply. That’s because narcotics are highly-regulated by the government to make sure they’re being used safely and effectively. And it’s better to fill specialty medications, which are used to treat complex conditions, in a smaller day supply because it can lower your costs due to wasted or unused medications if your prescription changes.
Do I need my doctor’s approval to switch to a 90-day prescription?
› Yes, you’ll need a prescription for a 90-day supply of your medication.
Are 90-day prescription fills available if I have Cigna Home Delivery Pharmacy?
› Yes. Call Cigna Home Delivery Pharmacy at 800.835.3784 to transfer your prescription.
Are there any benefits or advantages to a 90-day prescription?
› Yes - it’s more convenient, you have choice and it helps improve your health.
1. You’ll make fewer visits to the pharmacy to refill your medication.
2. You can choose where you want to fill your prescriptions – at a local 90-day retail pharmacy or through Cigna Home Delivery Pharmacy.
3. You’re more likely to stay healthy because having a 90-day supply of your medication on hand typically means you’re less likely to miss a dose.2
Are there any cost savings associated with 90-day prescription fills?
› Depending on your plan and your medication, you may be able to save money by filling your prescriptions 90 days at a time.
How do I switch pharmacies if:
› I have a 90-day prescription and just want to switch pharmacies?
Ask the new pharmacy of your choice to transfer your existing 90-day prescription from your current pharmacy.
› I’m currently using a local pharmacy and want to switch to Cigna Home Delivery Pharmacy?
Call Cigna Home Delivery Pharmacy at 800.835.3784 to transfer your existing 90-day prescription.
› I’m currently using Cigna Home Delivery Pharmacy and want to use a local pharmacy?
Ask the local pharmacy of your choice to call Cigna Home Delivery Pharmacy at 800.835.3784 to transfer your existing 90-day prescription.
– OR –
Call your doctor’s office and let your doctor know the name of your new pharmacy and he or she will send your prescription(s) to the pharmacy of your choice.
1. Plans vary, so some plans may not include Cigna Home Delivery Pharmacy. Please check your plan materials for more information on what pharmacies are covered under your plan.
2. Internal Cigna analysis performed March 2016, utilizing 2015 Cigna national book of business average medication adherence (customer adherent > 80% PDC), 90-day supply vs. those who received a 30-day supply taking antidiabetics, RAS antagonist and statins.
As a Cigna customer, you’ll have access to Cigna Home Delivery PharmacySM, designed especially for individuals who take prescription medications on a regular basis, such as those used for diabetes, asthma, heart conditions, high blood pressure and more.
You’ll enjoy:
› Easy refi lls – up to a 90-day supply means fewer refi lls
› Reminder service to refi ll or take your medication available at Cigna.com/CoachRx
› Our free QuickFill service will call or email you when it’s time to refi ll your prescriptions
› Fast answers from Cigna pharmacists 24/7
800.285.4812
Manage your medication
Log in to myCigna.com where you can obtain the following important information about your prescription medications:
› Compare medication prices
› Check order status
› Review number of refi lls remaining
› Order refi lls and more
QuickSwitch® – we make fi lling a prescription simple
Have the following information handy when you call. We’ll do the rest!
1. Name and Cigna ID number
2. Prescription medication names and dosage (for you or a covered family member)
3. Doctor information (name, phone number)
4. Payment information (American Express, Discover, MasterCard or VISA)
Off ered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affi liates.
“Cigna,” the “Tree of Life” logo and “QuickSwitch” are registered service marks, and “Together, all the way.” 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 by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO subsidiaries of Cigna Health Corporation, including Cigna HealthCare of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc., Cigna HealthCare of Florida, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc. (IL & IN), Cigna HealthCare of Indiana, Inc., Cigna HealthCare of St. Louis, Inc. (MO, KS & IL), Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of New Jersey, Inc., Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of Tennessee, Inc. (TN & MS), and Cigna HealthCare of Texas, Inc. “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C.
822825 d 11/14 © 2014 Cigna. Some content provided under license.
A PHARMACY
AT YOUR FINGERTIPS
Cigna Home Delivery Pharmacy
With this information, we will request a prescription from your doctor. Once we receive it, we will fi ll your medication and mail it to your home or other location of your choice.
What is Step Therapy? Prescription medications can cost a lot of money. At Cigna, we get that. That’s why we’ve created a program that helps you save money and stay healthy. It’s called Step Therapy.
Step Therapy is a prior authorization program. This means that certain medications in the Step Therapy program need approval before they’re covered. In Step Therapy, you and your doctor follow a series of steps when choosing your medication.
You may be able to choose from several different safe and effective prescription medications to treat your condition. Cost is often the biggest difference. Generic medications – which have the same strength and active ingredients as brand name medications – typically cost less, while brand name medications are usually the most expensive.
Included in the Step Therapy program are medications ued to treat several common medical conditions:
› ADD/ADHD
› Allergies
› Asthma
› Bladder problems
› Depression
› Heartburn/ulcer
› High blood pressure
How does Step Therapy work? Step Therapy encourages you to try the most cost-effective and appropriate medications available to treat your condition. Typically, these medications are generics or low-cost brands. You need to try these first, before more expensive medications are approved.
When you fill a prescription for a Step Therapy medication, you and your physician will receive a letter explaining what steps you need to take before you refill your medication. This may include trying a generic or lower cost alternative, or asking Cigna for authorization for coverage of your medication. At any time, your physician can request authorization to continue coverage of a Step Therapy medication for medical reasons.
Determining if your medication is included in the programGo to myCigna.com. Look up your prescription drug list to see if your specific medication is impacted by Step Therapy. If an “ST” designation appears next to the drug name, then the medication is part of the Step Therapy program.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
892819 03/16 © 2016 Cigna. Some content provided under license.
› High cholesterol
› Mental health
› Osteoporosis
› Pain (narcotic and non-narcotic)
› Skin conditions
› Sleep disorders
STEP THERAPY
Helps members make the switch to lower-cost medications
Cigna Payer Solutions
For more information, contact your employer’s benefit department, or the customer service number on the back of your ID card. We also encourage you to discuss Step Therapy with your physician.
Offered by: Cigna Health and Life Insurance Company or Connecticut General Life Insurance Company.
887152 c Advantage 3Tier w DRT 08/16 © 2017 Cigna.
CIGNA ADVANTAGE PRESCRIPTION DRUG LIST
Advantage Prescription Drug List – Three-Tier Plan
Understanding Cigna’s prescription drug list
Every year Cigna updates this drug list to reflect any changes to the list of covered prescription drugs. Examples of changes that may impact you include brand-name medications may change tiers or may no longer be covered. In addition, any new FDA-approved drug product (including, but not limited to, medications, medical supplies or devices that are covered under standard pharmacy benefit plans) available in the marketplace may not be covered^ for the first six months after the product receives FDA new drug approval. This document includes a summary of key changes made to common medications effective January 1, 2017.
Use the Prescription Drug Price Quote tool on myCigna.com to price a medication and see the lower-cost options available to you at your selected retail pharmacy and Cigna Home Delivery Pharmacy. Please note: This list is subject to change.
This document represents a list of the most commonly prescribed medications covered under your plan, in an easy-to-read format. If you do not see a specific medication on this list, please check myCigna.com to see all of the medications covered under your plan.
Choosing the medication that is right for you is between you and your doctor. Every medication available on Cigna’s prescription drug list has been approved by the U.S. Food and Drug Administration (FDA). If there is more than one medication appropriate for your condition, we encourage you to talk with your doctor about lower-cost medications like generics and preferred brands, as they will help to manage your prescription costs.
Your three-tier prescription drug list
A three-tier prescription drug list splits medications into three categories (or tiers):
1st Tier – Generic Medications have the same strength and active ingredients as the brand name – but often cost much less. You will usually pay less for generic medications under your plan. If one’s available, you should consider switching to a generic to treat your condition.
2nd Tier – Preferred Brand Medications will usually cost more than a generic, but less than a non-preferred brand medication under your plan.
3rd Tier – Non-Preferred Brand Medications are those that generally have generic alternatives and/or one or more preferred options within the same drug class. You will usually pay more for a non-preferred medication under your plan.
^ If your doctor feels currently covered medications aren’t right for you, he or she can ask Cigna to consider authorizing coverage of your medication.
January 2017
2
Important note
This drug list does not cover medications in two drug classes that have over-the-counter (OTC) alternatives (medications available without a prescription).* These include:
› Medications used to treat stomach acid conditions (ex., Nexium, PrevPac, Prilosec, Zantac and any generics), and
› Medications (non-sedating antihistamines) to treat allergies (ex., Allegra, Clarinex, Xyzal and any generics).
* Check your plan materials to see how these products are covered for you.
myCigna.com
Our customer website that can help you manage your prescription coverage. When you visit myCigna.com, you can:
› Look up the details of your specific pharmacy plan
› View your drug list to research thousands of available medications
› Compare medication prices using the Prescription Drug Price Quote tool
› Ask a pharmacist questions
› And much, much more.
Cigna Home Delivery Pharmacy
Cigna Home Delivery PharmacySM is a convenient mail order service for those who take medications regularly. We offer:
› Routine, maintenance medications and specialty medications
› Licensed pharmacists available to help answer questions, 24/7
› Up to a 90-day supply of your medications
› Free, standard shipping right to your home
› Refill reminder service
To get started, give us a call at 800.835.3784
For more information, visit the Cigna Home Delivery Pharmacy page on myCigna.com.
Health care reform and you
The Patient Protection and Affordable Care Act (PPACA), commonly referred to as “health care reform,” was signed into law on March 23, 2010. Certain preventive medications (including some over-the-counter medications) may be available to you at no cost-sharing. To get the most current information, visit InformedOnReform.com or Cigna.com and look for the Preventive Services section within the “Informed On Reform” link.
If you have any questions
Please call the toll-free number on the back of your Cigna ID card. We’re here to help.
Save time with the convenience of Cigna Home Delivery Pharmacy
PA: Prior Authorization may be required for different reasons. To learn the requirements needed for coverage of a specific medication, feel free to give us a call.
QL: Quantity Limit means you may have coverage for a limited amount of a specific medication.
AGE: Age Requirement means a person must be within a specific age group for a specific medication to be covered.
ST: Step Therapy is a prior authorization program that requires you to try other medications available to treat the same condition before the “ST” medication is covered.
GEN: Gender means this medication is only covered if you meet specific gender requirements.
The symbols on the list meanIf a medication on the list has one of the following symbols, your doctor may need to get an authorization (approval) for coverage of that medication.
* Medications marked with an asterisk are considered to be specialty medications. Some plans may cover specialty medications at different benefit levels or may require the use of a preferred specialty pharmacy. Refer to your plan documents for more information.
^ This medication may not be covered under your plan. Please check your enrollment materials or use the Prescription Drug Price Quote tool on myCigna.com to find out if this medication is covered.
3
2017 Cigna Prescription Drug List
ADVANTAGE PRESCRIPTION DRUG LIST THREE-TIER PLAN
GenericsPreferred Brands
Non-Preferred Brands
AIDS/HIV
lamivudine*
lamivudine-zidovudine*
nevirapine*
nevirapine ER*
Atripla*
Epzicom*
Intelence*
Isentress*
Kaletra*
Norvir softgel cap, solution*
Prezista*
Reyataz*
Selzentry*
Sustiva*
Truvada*
Viread 300mg*
Complera*
Genvoya*
Norvir tablet*
Odefsey*
Prezcobix*
Stribild*
Tivicay*
Triumeq*
Viread powder 150, 200, 250mg*
ALLERGY/NASAL SPRAYS
Check your plan materials or mycigna.com to see how these products within this category may be covered for you.
azelastine
budesonide
epinephrine (QL)
fluticasone
hydroxyzine
ipratropium
mometasone
olopatadine
Phenergan
promethazine
EpiPen 2-pak (QL)
EpiPen Jr 2-pak (QL)
Adrenaclick (QL)
Astepro
Bactroban Nasal
ALZHEIMER’S DISEASE
donepezil
donepezil ODT
memantine
pyridostigmine
pyridostigmine ER
rivastigmine
Mestinon
Namenda
Namenda XR
Namzaric
Regonol
ANXIETY/DEPRESSION/BIPOLAR DISORDER
alprazolam
alprazolam ER
alprazolam intensol
alprazolam ODT
alprazolam XR
amitriptyline
bupropion
bupropion SR
bupropion XL
Brisdelle (QL)
Celexa (ST)
Effexor XR (ST)
Fetzima (ST)
Forfivo XL (ST)
Irenka (ST)
Prozac (ST)
Prozac Weekly (ST)
Sarafem (ST)
GenericsPreferred Brands
Non-Preferred Brands
ANXIETY/DEPRESSION/BIPOLAR DISORDER (cont)
buspirone
citalopram
clomipramine
diazepam
duloxetine
escitalopram
fluoxetine DR
fluoxetine
fluvoxamine
fluvoxamine ER
lorazepam
lorazepam intensol
paroxetine
sertraline
trazodone
venlafaxine
venlafaxine ER
Venlafaxine ER (ST)
Viibryd (ST)
Wellbutrin SR (ST)
Xanax
Xanax XR
Zoloft (ST)
ASTHMA/COPD/RESPIRATORY
albuterol
budesonide
ipratropium-albuterol
levalbuterol concentrate
levalbuterol
montelukast
Advair Diskus
Advair HFA
Anoro Ellipta
Breo Ellipta
ProAir HFA
ProAir Respiclick
QVAR
Spiriva
Spiriva Respimat
Stiolto Respimat
Striverdi Respimat
Adcirca* (PA)
Adempas* (PA)
Combivent Respimat
Kalydeco* (PA)
Letairis* (PA)
Opsumit* (PA)
Orenitram ER* (PA)
Orkambi* (PA)
Pulmicort
Pulmozyme* (PA)
Remodulin* (PA)
Tracleer* (PA)
Tyvaso* (PA)
Xolair* (PA)
ATTENTION DEFICIT HYPERACTIVITY DISORDER
dexmethylphenidate
dexmethylphenidate ER
dextroamphetamine-amphet ER
dextroamphetamine- amphetamine
guanfacine ER
metadate ER
methylphenidate ER
methylphenidate
Adderall XR Adderall (ST)
Adzenys XR-ODT (ST)
Aptensio XR (ST)
Concerta (ST)
Daytrana (ST)
Dyanavel XR (ST)
Focalin (ST)
Focalin XR
Metadate CD (ST)
Methylin (ST)
Quillichew ER (ST)
4
2017 Cigna Prescription Drug List
GenericsPreferred Brands
Non-Preferred Brands
ATTENTION DEFICIT HYPERACTIVITY DISORDER (cont)
methylphenidate CD
methylphenidate LA
Quillivant XR (ST)
Ritalin (ST)
Ritalin LA (ST)
Strattera
BLOOD MODIFIERS/BLEEDING DISORDERS
tranexamic acid* Aranesp* (PA)
Droxia
Granix*
Neulasta* (PA)
Zarxio
Amicar*
Epogen* (PA)
Neupogen* (PA)
Procrit* (PA)
Promacta* (PA)
BLOOD PRESSURE/HEART MEDICATIONS
afeditab CR
amiodarone
amlodipine
amlodipine-benazepril
amlodipine-valsartan
amlodipine-valsartan-HCTZ
atenolol
atenolol-chlorthalidone
benazepril
benazepril-HCTZ
candesartan
cartia XT
carvedilol
clonidine
digitek
digox
digoxin
diltiazem CD
diltiazem ER
diltiazem
dilt-XR
enalapril
flecainide
hydralazine
irbesartan
isosorbide mononitrate
isosorbide mononitrate ER
labetalol
lisinopril
lisinopril-HCTZ
losartan potassium
losartan-HCTZ
matzim LA
metoprolol
nadolol
nifedical XL
nifedipine
nifedipine ER
Azor
Benicar (ST)
Benicar HCT (ST)
Corlanor (PA)
Entresto (PA))
Tribenzor
Berinert* (PA)
BiDil
Cardizem LA
Cinryze* (PA)
Coreg CR
Firazyr* (PA)
Hemangeol
Inderal LA
Inderal XL
Innopran XL
Multaq
Nitro-Dur
Nitrolingual
Nitromist
Nitrostat
Northera* (PA)
Norvasc
Ranexa (ST)
Tiazac
Tikosyn
Toprol XL
GenericsPreferred Brands
Non-Preferred Brands
BLOOD PRESSURE/HEART MEDICATIONS (cont)
Pacerone
propafenone
propafenone ER
propranolol
propranolol ER
ramipril
taztia XT
telmisartan
telmisartan-HCTZ
valsartan
valsartan-HCTZ
verapamil ER
verapamil
verapamil SR
BLOOD THINNERS/ANTI-CLOTTING
aspirin-dipyridamole ER
clopidogrel
enoxaparin* (QL)
fondaparinux* (QL)
jantoven
warfarin
Brilinta
Eliquis
Xarelto
Coumadin
Effient
Fragmin* (QL)
Pradaxa
CANCER
anastrozole
bexarotene*
capecitabine*
exemestane
hydroxyurea
imatinib* (PA)
letrozole
mercaptopurine
methotrexate*
tamoxifen citrate
temozolomide* (PA)
Actimmune* (PA)
Fareston
Gleostine
Intron A* (PA)
Nexavar* (PA)
Revlimid* (PA)
Sprycel* (PA)
Sutent* (PA)
Tarceva* (PA)
Targretin*
Tasigna* (PA)
Trexall*
Tykerb* (PA)
Afinitor* (PA)
Arimidex
Bosulif* (PA)
Cabometyx* (PA)
Cometriq* (PA)
Cotellic* (PA)
Erivedge* (PA)
Femara
Gilotrif* (PA)
Gleevec* (PA)
Ibrance* (PA)
Iclusig* (PA)
Imbruvica* (PA)
Inlyta* (PA)
Jakafi* (PA)
Lonsurf* (PA)
Lupron Depot* (PA)
Lynparza* (PA)
Ninlaro* (PA)
Pomalyst* (PA)
Stivarga* (PA)
Sylatron* (PA)
Tagrisso* (PA)
Tasigna* (PA)
Votrient* (PA)
Xalkori* (PA)
Xeloda*
Xtandi* (PA)
Zelboraf* (PA)
Zykadia* (PA)
Zytiga* (PA)
5
2017 Cigna Prescription Drug List
GenericsPreferred Brands
Non-Preferred Brands
CHOLESTEROL MEDICATIONS
amlodipine-atorvastatin
atorvastatin
fenofibrate
fenofibric acid
Lofibra 54, 160mg
lovastatin
niacin ER
omega-3 acid ethyl esters
pravastatin
rosuvastatin
simvastatin
Praluent* (PA)
Repatha* (PA)
Zetia
Korlym (PA)
Lofibra 67, 134, 200mg
Tricor
Vascepa (ST)
Welchol
CONTRACEPTIVE PRODUCTS
All contraceptive products may be covered if you meet specific gender requirements.
blisovi 24 FE
blisovi FE
drospirenone-ethinyl estradiol
estarylla
gianvi
gildess 24 FE
gildess FE
junel FE
junel FE 24
larin 24 FE
larin FE
lomedia 24 FE
loryna
microgestin FE
mono-linyah
mononessa
nikki
norethin-eth estra-ferrous fum
norgestimate-ethinyl estradiol
ocella
previfem
sprintec
syeda
tarina FE
tilia FE
tri-estarylla
tri-legest FE
tri-linyah
tri-lo-estarylla
tri-lo-marzia
tri-lo-sprintec
trinessa
Trinessa LO
tri-previfem
tri-sprintec
vestura
zarah
Beyaz
Lo Loestrin FE
LoSeasonique
Minastrin 24 FE
Seasonique
Estrostep FE
Loestrin FE
Microgestin 24 FE
Mirena*
NuvaRing
Skyla*
GenericsPreferred Brands
Non-Preferred Brands
COUGH/COLD MEDICATIONS
benzonatate
brompheniramine- pseudoephed-DM
hydrocodone-homatropine
hydrocodone- chlorpheniramne ER
hydrocodone-homatropine
hydromet
promethazine-codeine
tussigon
Flowtuss
Hycofenix
Tussionex
Tuzistra XR
DENTAL PRODUCTS
chlorhexidine
denta 5000 plus
dentagel
doxycycline
fluoride
fluoridex daily defense
fluoritab
flura-drops
ludent fluoride
oralone
paroex
peridex
periogard
sf
sf 5000 plus
sodium fluoride
triamcinolone
Clinpro 5000
Fluorabon
Fluor-a-day
Fluoridex Sensitivity Relief
Prevident
Prevident 5000
DIABETES
glimepiride
glipizide
glipizide ER
glipizide XL
metformin
metformin ER
pioglitazone-metformin
Glucagen HypoKit (QL)
Humalog
Humulin
Invokamet
Invokana
Janumet
Janumet XR
Januvia
Kombiglyze XR
Lantus
Lantus SoloStar
OneTouch test strips
Onglyza
SymlinPen
Toujeo SoloStar
Trulicity (QL)
Glucagon Emergency Kit (QL)
Glucophage
Glucophage XR
Riomet
VGo
6
2017 Cigna Prescription Drug List
GenericsPreferred Brands
Non-Preferred Brands
DIURETICS
acetazolamide
chlorthalidone
eplerenone
furosemide
hydrochlorothiazide
spironolactone
triamterene-HCTZ
Aldactone
Dyazide
Edecrin
Lasix
Maxzide
Samsca
EAR MEDICATIONS
fluocinolone oil
neomycin-polymyxin- hydrocortisone
Cipro HC
Ciprodex
Coly-mycin S
Cortane-b
Dermotic
EYE CONDITIONS
azelastine
brimonidine
ciprofloxacin
dorzolamide-timolol
erythromycin
fluorometholone
gatifloxacin
gentak
gentamicin
ketorolac
latanoprost
neomycin-polymyxin-dexameth
ofloxacin
olopatadine
polymyxin b sul-trimethoprim
prednisolone
timolol
tobramycin
tobramycin-dexamethasone
Simbrinza
Travatan Z
Acuvail
Alphagan P
Alrex
Azasite
Azopt
Bepreve
Besivance
Betimol
Betoptic S
Combigan
Cosopt PF
Cystaran
Durezol
Ilevro
Lastacaft
Lotemax
Moxeza
Nevanac
Omnipred
Pataday
Patanol
Pazeo
Pred Forte
Pred Mild
Prolensa
Restasis
Tobradex
Tobradex ST
Vigamox
Xalatan
Zioptan (ST)
Zirgan
Zylet
GenericsPreferred Brands
Non-Preferred Brands
FEMININE PRODUCTS
fem pH
gynazole 1
miconazole 3
terconazole
zazole
AVC
Relagard
Terazol
GASTROINTESTINAL/HEARTBURN
Check your plan materials or mycigna.com to see how these products within this category may be covered for you.
alosetron (GEN)
anucort-HC
balsalazide disodium
chlordiazepoxide-clidinium
dicyclomine
dronabinol
hemmorex-HC
hydrocortisone
lansoprazole-amoxicillin-clarithromycin (combo pak)
mesalamine
metoclopramide
metoclopramide ODT
ondansetron
ondansetron ODT
phenadoz
procto-med HC
procto-pak
proctosol-HC
proctozone-HC
promethazine
promethegan
sucralfate
ursodiol
Creon
Lialda
Pentasa
Zenpep
Amitiza
Canasa
Carafate
Cholbam* (PA)
Colyte
Diclegis
Donnatal
Emend* (QL)
Entyvio* (PA)
Gattex* (PA)
GoLytely
Linzess
Lotronex (GEN)
Movantik (PA)
Moviprep
Osmoprep
Pancreaze
Pertzye
Prepopik
Pylera
Ravicti (PA)
Rectiv
Sancuso (QL)
Sensipar*
sfRowasa
Suprep
Transderm-Scop
Varubi* (QL)
Viberzi
Viokace
HORMONAL AGENTS
budesonide EC
cabergoline (QL)
covaryx
covaryx H.S.
desmopressin*
dexamethasone
dexamethasone intensol
EEMT
EEMT H.S.
estradiol
estradiol-norethindrone acetat
estrogen & methyltestosterone
Androgel (QL)
Duavee
Humatrope* (PA)
Premarin
Premphase
Prempro
Sandostatin LAR Depot* (PA)
Serostim* (PA)
Somavert* (PA)
Zorbtive* (PA)
Activella
Alora
Androderm (QL)
Armour Thyroid
Climara
Climara Pro
Combipatch
Cytomel
Deltasone
Depo-Testosterone
Divigel
Elestrin
Enjuvia
Entocort EC
Estrace
7
2017 Cigna Prescription Drug List
GenericsPreferred Brands
Non-Preferred Brands
HORMONAL AGENTS (cont)
levothyroxine
levoxyl
liothyronine
lopreeza
medroxyprogesterone
methylprednisolone
millipred
millipred DP
mimvey
mimvey LO
nature-throid
NP thyroid
prednisolone
prednisolone ODT
prednisone
prednisone intensol
progesterone
testosterone
testosterone cypionate
westhroid
WP thyroid
Estring
Estrogel
Evamist
Femring
Forteo*
Ganirelix* ^
H.P. Acthar* (PA)
Lupron Depot* (PA)
Lupron Depot-Ped* (PA)
Menostar
Minivelle
Osphena
Somatuline Depot* (PA)
Striant (QL)
Synthroid
Testopel
Tirosint
Triostat
Unithroid
Vagifem
Vivelle-Dot
INFECTIONS
acyclovir
adefovir*
amoxicillin
amoxicillin ER
amoxicillin-clavulanate ER
amoxicillin-clavulanate
atovaquone
atovaquone-proguanil
avidoxy
azithromycin
cefdinir
cefixime
cefprozil
cefuroxime
cephalexin
ciprofloxacin
clarithromycin
clarithromycin ER
clindamycin
doxy 100
doxycycline
doxycycline IR-DR
entecavir*
erythromycin
famciclovir
fluconazole
hydroxychloroquine
Baraclude solution*
Daklinza* (PA)
Harvoni* (PA)
Kitabis Pak*
Sovaldi* (PA)
Tamiflu (QL)
Thalomid* (PA)
Albenza
Alinia
Bactrim
Bactrim DS
Baraclude tablet*
Cayston*
Ceftin
Cipro
Cleocin
Clindesse
Daraprim (PA)
Dificid (PA)
Diflucan
E.E.S.
Eryped
Ery-Tab
Metrogel-vaginal
Minocin
Monurol
Noxafil
Nuvessa
PCE
Plaquenil
Sporanox
Stromectol
Sulfatrim
Suprax
Synagis* (PA)
Tobi Podhaler*
GenericsPreferred Brands
Non-Preferred Brands
INFECTIONS (cont)
hydroxychloroquine
itraconazole
levofloxacin
linezolid (PA)
metronidazole
minocycline
minocycline ER
Moderiba*
mondoxyne NL
morgidox
moxifloxacin
nitrofurantoin
nystatin
penicillin
sulfamethoxazole-trimethoprim
terbinafine
tetracycline
tinidazole
tobramycin*
valacyclovir
valganciclovir
vancomycin
vandazole
voriconazole (PA)
Urelle
Uretron D-S
Uribel
Urogesic-blue
Uta
Valcyte
Valtrex
Vibramycin
Viekira Pak* (PA)
Xifaxan
Zepatier* (PA)
Zithromax
Zithromax Tri-pak
Zmax
Zovirax
Zyvox (PA)
INFERTILITY
clomiphene citrate^ Follistim AQ* ^ Crinone^
Endometrin^
Makena (PA)
Menopur* ^
MISCELLANEOUS
naltrexone
pulmosal
sodium chloride
Cerdelga* (PA) Addyi (QL, GEN)
Botox* (PA)
Cerezyme* (PA)
Esbriet* (PA)
Exjade*
Hyper-Sal
Jadenu*
Kuvan* (PA)
Myalept* (PA)
Nebusal
Nuedexta
Orfadin*
Strensiq* (PA)
Syprine
Vivitrol*
Xenazine* (PA)
Zavesca* (PA)
2017 Cigna Prescription Drug List
8
GenericsPreferred Brands
Non-Preferred Brands
MULTIPLE SCLEROSIS
glatopa* (PA) Ampyra* (PA)
Aubagio* (PA)
Avonex* (PA)
Betaseron* (PA)
Copaxone* (PA)
Extavia* (PA)
Gilenya* (PA)
Plegridy* (PA)
Rebif* (PA)
Tecfidera* (PA)
NUTRITIONAL/DIETARY
b-12 compliance
b-12 kit
calcitriol
calcium
ciferex
cyanocobalamin injection
folic acid
folixapure
Klor-Con
Klor-Con m10, m20
klor-con sprinkle
k-sol
multivitamin with fluoride
ortho d
pnv-DHA
potassium chloride
prena1 pearl
prenatal plus
prenatal vitamin plus low iron
preplus
rulavite DHA
virt-pn DHA
vitamin d2
zatean-pn DHA
zavara
Fosrenol
Nestabs DHA
OB Complete
Prefera OB
Renvela
Select-OB+ DHA
Auryxia
CitraNatal
Concept DHA
DermacinRx PureFolix
Durachol
Feriva 21-7
Ferralet 90
Integra Plus
Klor-Con
Klor-Con 8, 10meq
Klor-Con M15
K-Tab ER
Mephyton
MVC-Fluoride
Nascobal
Nicomide
Noxifol-d3
OB Complete Gold
Phoslyra
Physicians Ez
Poly-Vi-Flor
Prenatabs FA
Prenate
Renagel
Revesta
Velphoro
Vitafol
vitaMedMD
vitaPearl
OSTEOPOROSIS PRODUCTS
alendronate
ibandronate*
raloxifene
risedronate
Actonel (ST)
Atelvia (ST)
Evista
Prolia* (PA)
Xgeva* (PA)
PAIN RELIEF AND INFLAMMATORY DISEASE
acetaminophen-codeine
acitretin
allopurinol
baclofen
butalb-acetaminoph-caff-codein
Butrans (QL)
Enbrel* (PA)
Humira* (PA)
Hysingla ER (QL)
Oxycontin (QL)
Rasuvo* (PA)
Xtampza ER (QL)
Abstral (PA)
Actemra* (PA)
Actiq (PA)
Alsuma (QL)
Analpram HC
Alsuma (QL)
GenericsPreferred Brands
Non-Preferred Brands
PAIN RELIEF AND INFLAMMATORY DISEASE (cont)
butalb-acetaminoph-caff-codein
butalbital-
acetaminophen-caffe
calcipotriene-betamethasone
capacet
carisoprodol
celecoxib (QL)
cyclobenzaprine
dermacinrx prizopak
diclofenac
diclofenac ER
diclofenac-misoprostol
dihydroergotamine (QL)
endocet
etodolac
etodolac ER
fentanyl (QL)
fioricet
glydo
hydrocodone-acetaminophen
hydromorphone ER (QL)
hydromorphone
ibuprofen
indomethacin
ketorolac tromethamine (QL)
leflunomide
lidocaine
lidocaine viscous
lidocaine-prilocaine
lorcet
lorcet HD
lorcet plus
lortab
margesic
meloxicam
metaxall
metaxalone
methocarbamol
morphine
morphine ER (QL)
nabumetone
naproxen
naproxen CR
naproxen ER
oxycodone
oxycodone ER (QL)
oxycodone-acetaminophen
oxymorphone
Alsuma (QL)
Analpram HC
Celebrex (ST, QL)
Cimzia* (PA)
Colchicine
Colcrys
Cosentyx* (PA)
Cuprimine
D.H.E. 45 (QL)
Depen
Duragesic (QL)
Enstilar
Fentora (PA)
Flector (ST, QL)
Frova (QL)
Imitrex (QL)
Indocin
Lazanda (PA)
Lidoderm
Lidovex
Livixil Pak
Lp Lite Pak
Migranal (QL)
Mitigare
Monovisc* (PA)
Nucynta (QL)
Nucynta ER (ST, QL)
Onzetra Xsail (QL)
Opana
Opana ER (ST, QL)
Orencia* (PA)
Orthovisc* (PA)
Otezla* (PA)
Otrexup* (PA)
Oxaydo
Parafon Forte Dsc
Percocet
Procort
Proctofoam-HC
Relpax (QL)
Remicade* (PA)
Roxicodone
Savella
Stelara* (PA)
Subsys (PA)
Synvisc* (PA)
Synvisc-one* (PA)
Taclonex
Uloric
Voltaren (ST)
Xartemis XR (ST, QL)
Xeljanz* (PA)
Xeljanz XR* (PA)
Zohydro ER (ST, QL)
Zomig (QL)
2017 Cigna Prescription Drug List
9
GenericsPreferred Brands
Non-Preferred Brands
PAIN RELIEF AND INFLAMMATORY DISEASE (cont)
oxymorphone ER
primlev
relador pak
relador pak plus
rizatriptan (QL)
sumatriptan (QL)
tizanidine
tramadol (QL)
tramadol ER (QL)
vanatol LQ
verdrocet
vicodin
vicodin ES
vicodin HP
zolmitriptan (QL)
zolmitriptan ODT (QL)
PARKINSON’S DISEASE
amantadine
benztropine
bromocriptine
carbidopa-levodopa
carbidopa-levodopa ER
pramipexole
pramipexole ER
ropinirole ER
ropinirole
Azilect Apokyn* (PA)
Mirapex
Mirapex ER
Neupro
Rytary
Sinemet
Sinemet CR
SCHIZOPHRENIA/ANTI-PSYCHOTICS
aripiprazole
aripiprazole ODT
chlorpromazine
haloperidol
olanzapine
olanzapine ODT
olanzapine-fluoxetine
paliperidone ER
quetiapine
risperidone
risperidone ODT
ziprasidone
Seroquel XR Abilify Maintena
Fanapt (ST)
Invega (ST)
Invega Sustenna
Invega Trinza
Latuda (ST)
Rexulti (ST)
Saphris (ST)
Seroquel (ST)
SEIZURE DISORDERS
carbamazepine
carbamazepine ER
clonazepam
divalproex
divalproex ER
epitol
gabapentin
lamotrigine
lamotrigine ER
lamotrigine ODT
levetiracetam
Dilantin
Lamictal ODT
Lamictal XR starter kit
Lyrica
Aptiom
Banzel
Carbatrol
Depakote
Depakote ER
Depakote Sprinkle
Dilantin
Fycompa
Keppra
Keppra XR
Lamictal
GenericsPreferred Brands
Non-Preferred Brands
SEIZURE DISORDERS (cont)
levetiracetam ER
oxcarbazepine
roweepra
topiramate
topiramate ER
Lamictal XR
Onfi
Oxtellar XR
Phenytek
Qudexy XR
Sabril*
Spritam
Tegretol
Tegretol XR
Topamax
Topiramate ER
Trileptal
Trokendi XR
Vimpat
SKIN CONDITIONS
acitretin
adapalene (PA age)
avar
avar-E
bp 10-1
calcipotriene
calcitrene
claravis (QL)
clindacin ETZ
clindacin P
clindamycin-benzoyl peroxide
clobetasol
clodan
clotrimazole-betamethasone
cormax
desonide
desoximetasone
diclofenac
econazole nitrate
fluocinonide
fluorouracil
imiquimod
ketoconazole
metronidazole
mupirocin
myorisan (QL)
neuac
nystatin-triamcinolone
permethrin
rosadan
rosanil
sodium sulfacetamide-sulfur
ss 10-2
sss 10-5
Fluoroplex Acanya
Aczone
Atralin (PA age)
Avar
Avar LS
Avar-E LS
Avita (PA age)
Azelex
Cleocin T
Clindamax
Cordran (ST)
Denavir
Desonate (ST)
Desowen (ST)
Differin (PA age)
Drysol
Efudex
Elidel (ST)
Epiduo
Epiduo Forte
Evoclin
Exelderm
Finacea
Lokara
Metrocream
Metrogel
Metrolotion
Naftin
Nizoral
Olux (ST)
Onexton
Picato
Retin-A (PA age)
Rosula
Sklice
Soolantra
Sumadan
Sumaxin
Sumaxin TS
10
2017 Cigna Prescription Drug List
GenericsPreferred Brands
Non-Preferred Brands
SKIN CONDITIONS (cont)
sulfacetamide sodium-sulfur
sulfacleanse 8-4
tacrolimus
tretinoin (PA age)
tretinoin microsphere (PA age)
triamcinolone acetonide
triderm
zenatane (QL)
zencia
Tazorac
Temovate (ST)
Tolak
Topicort (ST)
Tretin-X (PA age)
Veltin
Xolegel
SLEEP DISORDERS/SEDATIVES
eszopiclone
modafinil (PA)
temazepam
zolpidem
zolpidem ER
Belsomra (ST)
Nuvigil (PA)
Silenor
Xyrem* (PA)
Zolpimist (ST)
SUBSTANCE ABUSE
buprenorphine
buprenorphine-naloxone (PA)
naloxone vial & PFS
Narcan Bunavail (PA)
Suboxone (PA)
Zubsolv (PA)
TRANSPLANT MEDICATIONS
azathioprine*
mycophenolate*
mycophenolic acid*
sirolimus*
tacrolimus*
Cellcept*
Prograf*
Astagraf XL*
Envarsus XR*
Myfortic*
Neoral*
URINARY TRACT CONDITIONS
cevimeline
doxazosin
dutasteride
dutasteride-tamsulosin
finasteride
oxybutynin
oxybutynin ER
phenazopyridine
potassium citrate ER
tamsulosin
terazosin
tolterodine
tolterodine ER
Avodart
Cystagon*
Detrol (ST)
Detrol LA (ST)
Elmiron
Enablex (ST)
Jalyn
Procysbi* (PA)
Rapaflo
Thiola
Urocit-K
* Medications marked with an asterisk are considered to be specialty medications. Some plans may cover specialty medications at different benefit levels or may require the use of a preferred specialty pharmacy. Refer to your plan documents for more information.
^ This medication may not be covered under your plan. Please check your enrollment materials or use the Prescription Drug Price Quote tool on myCigna.com to find out if this medication is covered.
11
Your Cigna plan doesn’t cover the medications listed below without prior approval from Cigna. This means that if you use any of these medications, you may have to pay the full cost of the medication at the pharmacy.
Talk with your doctor to see which one of the covered generic or preferred brand alternatives listed in this drug list might be right for you.
CONDITION/COMMON USE/ DRUG CLASS
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
ALLERGY/NASAL SPRAYS Beconase AQ
Dymista
Nasonex
Omnaris
QNASL
Veramyst
Zetonna
Generic nasal steroids (e.g. fluticasone)
QNASL Children budesonide
fluticasone
triamcinolone
ANXIETY/DEPRESSION/BIPOLAR DISORDER Aplenzin bupropion XL
Ativan lorazepam
Cymbalta duloxetine
Lexapro escitalopram
Pexeva paroxetine
Pristiq ER bupropion SR/XL
duloxetine
venlafaxine ER
all generic SSRIs
Wellbutrin XL bupropion XL (ER 24hr tablet)
ASTHMA/COPD/
RESPIRATORY
Aerospan
Alvesco
Arnuity Ellipta
Asmanex
Asmanex HFA
Flovent Diskus
Flovent HFA
Pulmicort Flexhaler
QVAR
Arcapta Neohaler
Serevent Diskus
Striverdi Respimat
Dulera
Symbicort
Advair HFA
Advair Diskus
Breo Ellipta
Incruse Ellipta
Tudorza Pressair
Spiriva
Spiriva Respimat
Proventil HFA
Ventolin HFA
Xopenex HFA
ProAir HFA
ProAir Respiclick
MEDICATIONS NOT COVERED TABLE
Medications NOT COVERED on your drug list^
12
CONDITION/COMMON USE/ DRUG CLASS
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
ATTENTION DEFICIT HYPERACTIVITY DISORDER
Vyvanse Adderall XR
dexmethylphenidate ER
dextroamphetamine-amphet ER
methylphenidate ER/LA
BLOOD PRESSURE/HEART MEDICATIONS Accupril quinapril
Accuretic quinapril-HCTZ
Aceon perindopril erbumine
Altace ramipril
Atacand candesartan
Atacand-HCT candesartan-HCTZ
Avalide irbesartan-HCTZ
Avapro irbesartan
Bystolic Generic beta blockers (e.g. metoprolol, atenolol)
Cardizem diltiazem
Cardizem CD Cartia XT
diltazem CD/ER
Cozaar losartan
Diovan valsartan
Diovan HCT valsartan-HCTZ
Edarbi Generic ARBs (e.g. losartan; valsartan)
Edarbyclor Generic ARBs + HCTZ (e.g. losartan-HCTZ)
Exforge amlodipine-valsartan
Exforge HCT amlodipine-valsartan-HCTZ
Hyzaar losartan-HCTZ
Isordil
Isordil Titradose
isosorbide dinitrate
Lanoxin Digitek
digoxin
Lotensin benazepril
Lotrel amlodipine-benazepril
Mavik trandolapril
Micardis telmisartan
Micardis HCT telmisartan-HCTZ
Prinivil
Zestril
lisinopril
Tarka trandolapril-verapamil ER
Tekturna Generic ACE/ARBs
Tekturna HCT Generic ACE/ARBs + HCTZ
Twynsta telmisartan-amlodipine
Vaseretic enalapril-HCTZ
Vasotec enalapril
Zestoretic lisinopril-HCTZ
Medications NOT COVERED on your drug list^
13
CONDITION/COMMON USE/ DRUG CLASS
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
CHOLESTEROL MEDICATIONS Altoprev atorvastatin
lovastatin
rosuvastatin
simvastatin
Antara
Fenoglide
fenofibrate
Crestor rosuvastatin
Lescol XL fluvastatin ER
Lipitor atorvastatin
Livalo atorvastatin
rosuvastatin
simvastatin
Pravachol pravastatin
Vytorin atorvastatin
rosuvastatin
simvastatin
Zetia
Zocor simvastatin
COUGH/COLD
MEDICATIONS
Tussicaps hydrocodone-chlorpheniramne ER
promethazine-codeine
DIABETES ACCU-CHEK, Contour, Freestyle, all
other test strips
OneTouch Ultra, OneTouch Verio
Afrezza
Apidra
Apidra SoloStar
Humalog
alogliptin
alogliptin-metformin
Jentadueto
Kazano
Nesina
Tradjenta
Janumet/Janumet XR
Januvia
Kombiglyze XR
Onglyza
alogliptin-pioglitazone
Oseni
Janumet/Janumet XR
Januvia
Kombiglyze XR
Onglyza
Generic TZDs (e.g. pioglitazone)
Bydureon
Byetta
Tanzeum
Victoza
Trulicity
Farxiga
Jardiance
Synjardy
Xigduo XR
Invokamet/Invokana
Glumetza
metformin ER (generic Fortamet)
metformin ER (generic Glucophage XR)
Glyxambi Invokamet/Invokana
Janumet/Janumet XR
Januvia
Kombiglyze XR
Onglyza
14
Medications NOT COVERED on your drug list^
CONDITION/COMMON USE/ DRUG CLASS
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
DIABETES (cont) Levemir
Tresiba
Lantus
Lantus SoloStar
Toujeo
Novolin, Novolog Humalog, Humulin
EYE CONDITIONS Lumigan bimatoprost
latanoprost
Travatan Z
travoprost
GASTROINTESTINAL/HEARTBURN Anusol-HC
Cortifoam
Uceris foam
Anucort-HC
GRx HiCort 25
Hemmorex-HC
hydrocortisone
Procto-med HC
Proctosol-HC
Proctozone-HC
Rectacort-HC
Asacol-HD
Colazal
Delzicol
Dipentum
Giazo
Apriso
balsalazide
Lialda
Pentasa
sulfasalazine
sulfasalazine DR
Librax chlordiazepoxide-clidinium
Metozolv ODT metoclopramide
metoclopramide ODT
Pepcid famotidine
Proctocort Hemmorex-HC
Hemril
hydrocortisone
Procto-Pak
Zuplenz ondansetron
ondansetron ODT
HORMONAL AGENTS Axiron
Fortesta
Natesto
Testim
Vogelxo
Androgel
testosterone
Dexpak dexamethasone
Genotropin
Norditropin Flexpro
Nutropin AQ
Omnitrope
Saizen
Zomacton
Humatrope (PA)
Rayos prednisone
prednisone intensol
Uceris tablet budesonide EC
15
Medications NOT COVERED on your drug list^
CONDITION/COMMON USE/ DRUG CLASS
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
INFECTIONS Acticlate
Adoxa
Adoxa Pak
Doryx
Minocin capsule
Monodox
Oracea
Solodyn
Vibramycin capsule
Generic products (e.g. doxycycline; minocycline)
Bethkis
Tobi
Kitabis Pak
tobramycin
Onmel itraconazole
terbinafine
Sitavig acyclovir
INFERTILITY Gonal-F
Gonal-F RFF
Gonal-F RFF Redi-ject
Follistim AQ (PA)
MISCELLANEOUS Horizant gabapentin
PAIN RELIEF AND INFLAMMATORY DISEASE Amrix cyclobenzaprine
Other generic muscle relaxants
Bupap butalbital-acetaminophen
marten-tab
tencon
Belbuca Butrans
Cambia
Diclofenac
Duexos
Klofensaid II
Pennsaid
Tivorbex
Vimovo
Vivlodex
Zipsor
Zorvolex
Generic prescription NSAIDs (e.g., celecoxib, meloxicam)
Capital W-codeine acetaminophen-codeine
Conzip tramadol
tramadol ER
Gralise gabapentin
Kineret
Simponi
Simponi Aria
Enbrel (PA)
Humira (PA)
Lidocaine
Lido-K
lidocaine
lidopin
Lorzone chlorzoxazone
Sprix ketorolac
Sumavel Dosepro sumitriptan
Treximet
Zembrace Symtouch
Generic NSAIDs
Generic triptans (e.g. sumatriptan; naratriptan)
Zomig ZMT zolmitriptan ODT
16
Medications NOT COVERED on your drug list^
CONDITION/COMMON USE/ DRUG CLASS
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
SCHIZOPHRENIA/ANTI-PSYCHOTICS Abilify aripiprazole
Fazaclo
Versacloz
clozapine
clozapine ODT
SEIZURE DISORDERS Mysoline primidone
SKIN CONDITIONS Absorica Claravis
Myorisan
Zenatane
Aldara imiquimod
Bensal HP Salacyn
salicylic acid
Benzaclin
Duac
Neuac kit
clindamycin-benzoyl peroxide
Neuac gel
Carac fluorouracil
Clindagel clindamycin
Clobex clobetasol
Ertaczo
Extina
ketoconazole
ketodan
Halog
Ultravate X
clobetasol
halobetasol
Jublia
Kerydin
Ciclodan
ciclopirox
itraconazole
terbinafine
Kenalog
Trianex
triamcinolone
Locoid
Locoid Lipocream
hydrocortisone
Loprox ciclopirox
Luzu
Vusion
ketoconazole
Noritate metronidazole
Rosadan
Novacort hydrocortisone
Oxistat clotrimazole
econazole
ketoconazole
Penlac ciclodan
ciclopirox
Plexion sodium sulfacetamide-sulfur
SS 10-2
zencia
Salex salicylic acid
Vanos fluocinonide
Verdeso desonide
Xerese acyclovir
hydrocortisone
Ziana clindamycin
tretinoin
Zovirax acyclovir
Zyclara imiquimod
17
Medications NOT COVERED on your drug list^
CONDITION/COMMON USE/ DRUG CLASS
MEDICATION NOT COVERED^GENERIC AND/OR PREFERRED BRAND ALTERNATIVES
SLEEP DISORDERS/SEDATIVES Ambien
Ambien CR
Edluar
Intermezzo
zolpidem
zolpidem ER
SUBSTANCE ABUSE Evzio Narcan
URINARY TRACT CONDITIONS Myrbetriq
Toviaz
VESIcare
darifenacin ER
oxybutynin chloride ER
tolterodine ER
trospium chloride ER
^ This drug is not covered on your plan. Please talk with your doctor about switching to an alternative. Your prescription drug plan requires approval by Cigna to have this medication covered.
18
EXCLUSIONS & LIMITATIONS
› over-the-counter (OTC) medications (medications that do not require a prescription) except insulin unless state or federal law requires coverage of such drugs;
› prescription drugs or supplies for which there is a non-prescription or OTC therapeutic alternative;
› physician-administered injectable medications covered under the Plan’s medical benefit, unless otherwise covered under the plan’s prescription drug list or authorized by Cigna;
› implantable contraceptive devices covered under the Plan’s medical benefit;
› medications that are not medically necessary;
› experimental or investigational medications, including FDA-approved drugs used for purposes other than those approved by the FDA unless the drug is recognized for the treatment of the particular indication;
› medications that are not approved by the Food & Drug Administration (FDA);
› prescription and non-prescription devices, supplies, and appliances other than those supplies specifically listed as covered;
› medications used for fertility, sexual dysfunction, cosmetic purposes, weight loss, smoking cessation, or athletic enhancement;
› prescription vitamins (other than prenatal vitamins) or dietary supplements unless state or federal law requires coverage of such drugs;
› immunization agents, biological products for allergy immunization, biological sera, blood, blood plasma and other blood products or fractions and medications used for travel prophylaxis;
› replacement of prescription drugs and related supplies due to loss or theft;
› drugs which are to be taken by or administered to a covered person while they are a patient in a licensed hospital, skilled nursing facility, rest home or similar institution which operates on its premises or allows to be operated on its premises a facility for dispensing pharmaceuticals;
› prescriptions more than one year from the date of issue; or
In addition to the plan’s standard pharmacy exclusions, certain new FDA-approved drug products (including but not limited to medications, medical supplies or devices that are covered under standard pharmacy benefit plans) may not be covered for the first six months of market availability unless authorized by Cigna as medically necessary.
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 be medically necessary. If your plan provides coverage for certain preventive prescription drugs with no cost-share, covered employees may be required to use an in-network pharmacy to fill the prescription. If employees use a pharmacy that does not participate in your plan’s network, the prescription may not be covered. Certain drugs may require prior authorization, or be subject to step therapy, quantity limits or other utilization management requirements.
Plans generally do not provide coverage for the following under the pharmacy benefit, except as required by state or federal law, or by the terms of your specific plan1:
1. Costs and complete details of the plan’s prescription drug coverage are set forth in the plan documents. If there are any differences between the information provided here and the plan documents, the information in the plan documents takes complete precedence.
In accordance with Texas and Louisiana state law, customers with affected benefit plans who receive coverage for medications that are removed from the prescription drug list during the plan year will continue to have those medications covered at the same benefit level until their plan renewal date. To find out if these state mandates apply to your plan, please call Customer Service.
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.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company (CGLIC), Cigna Behavioral Health, Inc., Cigna Health Management, Inc., Tel-Drug, Inc., and Tel-Drug of Pennsylvania, L.L.C. “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. Policy forms: OK - HP-APP-1 et al (CHLIC), GM6000 C1 et al (CGLIC); TN - HP-POL43/HC-CER1V1 et al (CHLIC). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
887152 c Advantage 3Tier w DRT 08/16 © 2017 Cigna. Some content provided under license.
Drug Name
ORAL AND SELF INJECTABLE SPECIALTY LIST
Specialty medications are used to treat complex conditions like multiple sclerosis, hepatitis C and rheumatoid arthritis. The following is a list of specialty pharmacy medications. These are covered under your pharmacy benefit. Those medications marked with an asterisk must be obtained through Cigna Home Delivery Pharmacy for it to be covered. This only applies when the medication is covered under the pharmacy benefit and when your plan requires the use of Cigna Home Delivery Pharmacy for specialty medications. Please note, this list is subject to change.
Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates.
891437 10/16 © 2016 Cigna.
Aabacavirabacavir-lamivudine-
zidovudineActemra*Actimmune*Adcirca*adefovir dipivoxil*AdempasAfinitor*Afinitor DisperzAgrylin*AkynzeoAlecensa*AlkeranAmicar*aminocaproic acid*Ampyra*Anagrelide*AnzemetApokyn*AptivusArcalystAstagraf XL*
AtriplaAubagio*Avonex*Azasan*azathioprine*
BBaraclude*Betaseron*bexarotene*bicalutamide*Bosulif*
CCabometyxcapecitabine*CaprelsaCasodex*CaystonCellcept*Cerdelga*CholbamCimzia*Combivir
CometriqCompleraCopaxone*Copegus*Cosentyx*Cotellic*Crixivancyclophosphamide*cyclosporine*Cystadane*Cystagon
DDaklinza*Descovydidanosine
EEdurantEgrifta*Emcyt*Emend (cap, sol)EmtrivaEnbrel*
entecavir*Envarsus XR*EpclusaEpivirEpivir HBVEpzicomErivedge*Esbriet*EvotazExjade*Extavia*
FFarydakFirazyr*flutamide*Fuzeon
GGattexGengraf*Genotropin*GenvoyaGilenya*
2
Drug Name
GilotrifGlatopa*Gleevec*
HHarvoni*Hecoria*Hepsera*Hexalen*Humatrope*Humira*Hycamtin*
IIbrance*Iclusigimatinib*ImbruvicaImuran*Incivek*IncrelexInfergen*Inlyta*IntelenceInviraseIressaIsentress
JJadenu*JakafiJuxtapid
KKaletraKalydecoKineret*Kynamro
Llamivudinelamivudine HBVlamivudine-zidovudineLenvimaLetairis*leucovorin*LexivaLonsurfLynparza
MMatulaneMekinist*Mesnexmethotrexate*Moderiba*Myalept
mycophenolate*mycophenolic acid*Myfortic*
NNatparaNeoral*nevirapinenevirapine ERNexavar*NinlaroNorditropin*NortheraNorvirNuplazidNutropin AQ*
OOcalivaOdefseyOdomzo*OfevOlysio*Omnitrope*Opsumit*Orencia*Orenitram EROrfadinOrkambiOtezla*Otrexup
Pparicalcitol*Pegasys*Pegintron*Plegridy*Pomalyst*Praluent*PrezcobixPrezistaProcysbiPrograf*Promacta*Pulmozyme*Purixan
RRapamune*RasuvoRebetol*Rebif*Rebif Rebidose*Repatha*RescriptorRetrovirRevatio*
Revlimid*ReyatazRheumatrexRibasphere*Ribasphere Ribapak*Ribatab*ribavirin*Rilutek*riluzole*
SSabrilSaizen*Sandimmune*SelzentrySensiparSerostim*Signiforsildenafil*Simponi*Simponi Aria*Sirolimus*SomavertSovaldi*Sprycel*stavudineStelara*Stivarga*StrensiqStribildSucraidSustivaSutent*Sylatron*
Ttacrolimus*Tafinlar*TagrissoTaltz*Tarceva*Targretin*Tasigna*Tecfidera*Technivie*Temodar*temozolomide*tetrabenazineTev-Tropin*Thalomid*TivicayTobi Podhaler*Tracleer*Trexall*TriumeqTrizivirTruvada
TybostTykerb*Tyzeka*
UUptravi
VVarubiVenclextaVentavisVictrelis*VidexVidex ECViekira Pak*ViraceptViramuneViramune XRVirazole*VireadVistogardVitektaVotrient*
XXalkori*Xeljanz*Xeljanz XR*Xeloda*XenazineXolair*Xtandi*XuridenXyrem
ZZavescaZelboraf*Zemplar*Zepatier*ZeritZiagenzidovudineZinbrytaZolinzaZomacton*ZorbtiveZortress*ZydeligZykadiaZytiga*
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. 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 (CHLIC), Connecticut General Life Insurance Company (CGLIC), Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of Cigna Health Corporation, including Cigna HealthCare of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc., Cigna HealthCare of Florida, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Indiana, Inc., Cigna HealthCare of St. Louis, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of New Jersey, Inc., Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of Tennessee, Inc. (CHC-TN), and Cigna HealthCare of Texas, Inc. “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. Policy forms: OK - HP-APP-1 et al (CHLIC), GM6000 C1 et al (CGLIC); TN - HP-POL43/HC-CER1V1 et al (CHLIC), GSA-COVER, et al (CHC-TN). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
891437 10/16 © 2016 Cigna. Some content provided under license.
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.
Prescription Drug Claim Form
583522j Rev. 01/2015
Insured and/or Administered by Connecticut General Life Insurance Company Cigna Health and Life Insurance Company Cigna HealthCare*
REASON FOR REIMBURSEMENT
This claim form can be used to request reimbursement for covered expenses. Please check which reason applies (at least one must be checked):
Out-of-Network Compound Prescription (Pharmacist: Claims must list ALL ingredients along with itemized NDCs, quantities and charges.)
For Health Care Reform related Over-the-Counter reimbursement requests, include your Doctor’s prescription.
PARTICIPANT/PATIENT INFORMATION
Non-Participating Pharmacy
Other (Please explain)Eligibility (Please explain)
Emergency
2)
DRUG NAME & STRENGTH
PHARMACY NAME
NDC
_____ / _____ / _____ ______________ ________ _____________DATE FILLED RX NUMBER DAY SUPPLY
PHARMACY NABP
PHARMACY ADDRESS
$
QTY
AMT. PAID
1)
DRUG NAME & STRENGTH
PHARMACY NAME
NDC
_____ / _____ / _____ ______________ ________ _____________DATE FILLED RX NUMBER DAY SUPPLY
PHARMACY NABP
PHARMACY ADDRESS
$
QTY
AMT. PAID
PRESCRIPTION INFORMATION
Primary coverage is with another insurance carrier. Please provide explanation of benefits (EOB) or denial letter from the primary insurance carrier.
Participant Name:
REASON FOR REIMBURSEMENT
PARTICIPANT/PATIENT INFORMATION
PRESCRIPTION INFORMATION
REASON FOR REIMBURSEMENT
PARTICIPANT/PATIENT INFORMATION
PRESCRIPTION INFORMATION
Patient Relationship to Participant: Patient Sex:
Male FemaleSpouseSelf (Participant) Dependent
I represent that the patient information entered on this form is correct, that the patient named is eligible for the benefits and that the patient has received the medication described. I also represent that the medication received is not for treatment of an on-the-job injury. I also authorize release of all information pertaining to this claim to the plan administrator or its designees.
Any person who knowingly and with intent to defraud any insurance company or other person: (1) files an application for insurance or statement of claim containing any materially false information; or (2) conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act which is a crime. For residents in the following states, please see the last page of this form: Alaska, Arizona, California, Colorado, District of Columbia, Florida, Kentucky, Maryland, Minnesota, New Jersey, New York, Oregon, Pennsylvania, Tennessee, Texas and Virginia.
Patient Signature: Date: Daytime Phone Number:
Cigna ID Number or Participant Social Security Number: (on the front of your Cigna ID card)
Employer:
Account Number: (on the front of your Cigna ID card)
Patient Name (use a separate form for each family member): Patient Birth Date: (Mo., Day, Year)
Multi-Ingredient Compound Prescription Information - To be Completed by Dispensing Pharmacy.
Pharmacist: If an itemized compound drug receipt is not available, please use this form to list the ingredients. 1. Use one form for each multi-ingredient compound prescription. Copy the form as needed. 2. The patient should send receipt(s) showing the out-of-pocket cost, and the Prescriber's name and DEA #. 3. SIGN the receipt. The information below is required to process multi-ingredient claim submissions. For each NDC number, indicate the "metric quantity" expressed in the number of tablets, grams, milliliters, injectables, etc. and the cost.
Quantity Valid NDC Drug Name Customer's Charge
1
2
3
4
5
INSTRUCTIONS
Fold
1.
2.
3.
4.
5.
6.
Complete ALL information on the front side of this form. Forms missing information may be denied, delayed orreturned. If you need help completing this form, contact your pharmacist.
Sign and date the Certification Statement in the area provided. Keep a copy of all forms and receipts for your records.
The Prescription Information section must be completed for each prescription for which you are seekingpayment.
For Health Care Reform related over-the-counter payment requests, include your Doctor's prescription. Please keep a copy of the prescription for your records.
Submit a separate form for each family member.
Mail the claim form within 12 months of the prescription fill date, along with original receipts (cash registerreceipts alone are not acceptable), to:
Fold
7.
RETURN ADDRESS
IMPORTANT: PLEASE PROVIDE CURRENT ADDRESS INFORMATION BELOW:
CUSTOMER STREET ADDRESS
CUSTOMER NAME
CUSTOMER CITY, STATE, ZIP
Cigna Pharmacy Service Center P.O. Box 188053 Chattanooga, TN 37422-8053
This Prescription Drug Claim Form is for Cigna customer use only. If you are a pharmacy, and need to file a claim, please contact Catamaran Provider Relations at
www.catamaranrx.com/pharmacies
Questions? Please call the Cigna number located on your ID card.
Did you know?
We may be able to reimburse you for any prescriptions you paid for directly and didn't use your insurance to cover. For instance, if you used a non-participating pharmacy, and your plan covers out-of-network purchases, file a claim.
We'll review it and look to see if we can get you a possible refund.
Prescribed medical equipment (or supplies) - Ask your medical plan about benefits for equipment. FSA and HRA expenses - Contact your FSA (or HRA) payer for a claim address and instructions. Prescriptions purchased by customers not enrolled with a Cigna drug plan - Check your benefit materials to see if your employer chose a Pharmacy Benefits Company other than Cigna. Non-covered drugs - See the "Exclusions and limitations" section of your plan's drug list.
Please do not submit claims for:....
583522j Rev. 01/2015
*"Cigna HealthCare" refers to the various HMO subsidiaries of Cigna Health Corporation. If you are enrolled in a Cigna HMO plan, complete details can be found in your plan documents or Evidence of Coverage.
"Cigna" is a registered service mark, and the "Tree of Life" logo 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 by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Health Management, Inc., and HMO subsidiaries of Cigna Health Corporation.
Caution: Any person who, knowingly and with intent to defraud any insurance company or other person: (1) files an application for insurance or statement of claim containing any materially false information; or (2) conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act.
IMPORTANT CLAIM NOTICE
Alaska Residents: A person who knowingly and with intent to injure, defraud or deceive an insurance company or files a claim containing false, incomplete or misleading information may be prosecuted under state law. Arizona Residents: For your protection, Arizona law requires the following statement to appear on/with this form. Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties. California Residents: For your protection, California law requires the following to appear on/with this form. Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. Colorado Residents: It is unlawful to knowingly provide false, incomplete or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies. District of Columbia Residents: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. Florida Residents: Any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of claim or an application containing any false, incomplete or misleading information is guilty of a felony of the third degree. Kentucky Residents: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. Maryland Residents: Any person who knowingly OR willfully presents false or fraudulent claim for payment of a loss or benefit or who knowingly OR willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Minnesota Residents: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. New Jersey Residents: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties. New Mexico Residents: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties. New York Residents: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall also be subject to a civil penalty not to exceed $5000 and the stated value of the claim for each such violation. Oregon Residents: Any person who knowingly and with intent to defraud any insurance company or other person: (1) files an application for insurance or statement of claim containing any materially false information; or, (2) conceals for the purpose of misleading, information concerning any material fact, may have committed a fraudulent insurance act. Pennsylvania Residents: Any person who, knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Rhode Island Residents: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Tennessee Residents: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. Texas Residents: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. Virginia Residents: Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may have violated state law.
Please complete this form for NEW and REFILL
prescription medication. You can also order refills
online at the website on your ID card.
Print all information clearly as shown in the
sample below using BLUE or BLACK ink.
Fill in the applicable ovals completely ( ).
Step 1: Insurance Cardholder Information Complete if above has changed or appears blank
--
--
-
email _______________________________________________________
Step 2: Allergies & Health Conditions Complete this section every time
Cigna Home Delivery Pharmacy
Prescription Order Form
1 2 3 4 A B C D
*10450001*10450001
Rev. 2.0 1/12
Address above is a one time address
514
Name (start with cardholder)
New customers must complete this section.
If left blank will mean no known drug allergies or
no change from information provided previously to
Cigna Home Delivery Pharmacy.
Other (list belo
w)
Hig
h C
hole
sterol
GI/G
ER
D
Asthm
a
Hig
h B
lood
Pressure
Dia
betes
Aspirin
NS
AID
S
Other (list belo
w)
Erythrom
ycin
Sulfa
No
ne
Please write the individual’s name and list their other allergies and other health conditions referenced above:
Allergies Health Conditions
//M YYDDM
Codein
e/M
orphin
e
Penic
illin
L MANTSA E
A
C
R S ENILS 1EDD
A R S ENILS 2EDD I T Y
S T Z I P
P H O N E #
F I R S T N A M E
Person completing __________________________________________
A L T P H O N E #
M
F EMNTSRI A
L EMNTSA A
Date of Birth
//M YYDDMF EMNTSRI A
L EMNTSA A
//M YYDDMF EMNTSRI A
L EMNTSA A
//M YYDDMF EMNTSRI A
L EMNTSA A
C INGI DA
Order updates, reminders and other educational information may be sent to the email
address above for the following individuals: ___________________________________________
_______________________________________________________________________________________
“Cigna" is a registered service mark, and the “Tree of Life” logo and “Cigna Home Delivery Pharmacy” are service marks, of Cigna Intellectual Property,
Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through 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 subsidiaries of Cigna Health Corporation.
“Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C.
Check ( ) One
*10450002*10450002
Step 5: Refill Prescriptions Attach label OR complete requested information
Print Prescription Number Here
Individual’s Name _______________________
Date of Birth ___________________________
Drug Name ____________________________
Remember to include the original prescription(s) from your doctor(s).
You can call us at 1.800.835.3784 or visit the website on your ID card. You can also write to us or
mail this order form to Cigna Home Delivery Pharmacy, PO Box 1019, Horsham PA 19044.
Step 6: New Prescriptions Include original written prescription from your doctor
Pharmacy law allows pharmacists to substitute a less expensive generically equivalent medication for a brand name medication
unless you or your doctor request the brand. By checking ( ) “Brand Only”, you may be responsible for a higher cost.
Individual’s Full Name Date of Birth
Fill
Now
Do Not
Fill
Now Medication Name & Strength
( ) if
Brand
Only Doctor’s Full Name
Standard Shipping USPS Priority Mail Overnight Delivery2 - 3 Days$0.00 $17.95$9.25
Refrigerated shipments will be expedited at no additional cost. You are responsible for the cost of SPECIAL SHIPPING which
expedites carrier delivery time only. Order processing is not affected by SPECIAL SHIPPING. These costs may be subject to
change by carrier without prior notification and may vary depending on weight and zone.
Credit / Debit Card #
VISA
Money OrderCheck
American Express
Discover
MasterCard
Please make check or money order payable to Cigna Home Delivery Pharmacy
.$Total payment enclosed (excluding credit card payment):
I allow Cigna Home Delivery Pharmacy to bill my credit / debit card for this and all future orders. I understand that my credit
/ debit card will be billed the following amounts in effect at the time my order is filled: any applicable copayment(s), coinsur-
ance and/or deductible(s), payments due for any medications not covered, plus any special shipping costs.
Use Credit / Debit Card on File
/
Expiration Date
Step 4: Method of Payment
Step 3: Shipping Method
,
/Expiration DateLast 4 digits of Credit / Debit Card
Check
Print Prescription Number Here
Individual’s Name _______________________
Date of Birth ___________________________
Drug Name ____________________________
Print Prescription Number Here
Individual’s Name _______________________
Date of Birth ___________________________
Drug Name ____________________________
Print Prescription Number Here
Individual’s Name _______________________
Date of Birth ___________________________
Drug Name ____________________________
Please write the date of birth and the Cigna ID on the back of each prescription.
PHARMACY DIRECTORYParticipating pharmacies in the United States, the U.S. Virgin Islands, Puerto Rico and Guam
Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affiliates.
589901 l 01/15
PHARMACY DIRECTORYAlabamaCare Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Fred Meyer Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Medicine Shoppe Pharmacy
Publix Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Winn-Dixie Pharmacy
AlaskaCarrs Quality Centers
Costco Pharmacy
Fred Meyer Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
ArizonaBashas’ United Drug
Cigna HealthCare Centers
Care Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Fry’s Food & Drug
Kmart Pharmacy
Medicine Shoppe Pharmacy
Osco Drug
Osco Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Savon Pharmacy
Smith’s Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
ArkansasBrookshire Pharmacy
CVS Pharmacy
Fred’s Pharmacy
Harps Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Price Cutter Pharmacy
Sam’s Pharmacy
Savon Pharmacy
Super D Drugs
Target Pharmacy
USA Drug Express
USA Drug
Walgreens Pharmacy
Walmart Pharmacy
CaliforniaBel-Air Pharmacy
Care Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Horton and Converse Pharmacy
Kmart Pharmacy
Medicine Shoppe Pharmacy
Nob Hill Pharmacy
Pavilions Pharmacy
Raley’s Pharmacy
Ralphs Pharmacy
Rite Aid Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Save Mart Pharmacy
Savon Pharmacy
Shopko Pharmacy
Super Rx Pharmacy
Target Pharmacy
Von’s Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
ColoradoAlbertson’s Pharmacy
City Market Pharmacy
Care Plus/CVS Pharmacy
Costco Pharmacy
King Sooper’s Pharmacy
Kmart Pharmacy
Medicine Shoppe Pharmacy
Rite Aid Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Savon Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
ConnecticutA&P Pharmacy
Big Y Pharmacy
Costco Pharmacy
Care Plus/CVS Pharmacy
CVS Pharmacy
Medicine Shoppe Pharmacy
Price Chopper Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Shoprite Pharmacy
Stop & Shop Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
DelawareCostco Pharmacy
CVS Pharmacy
Giant Pharmacy
Harris Teeter Pharmacy
Kmart Pharmacy
Pathmark Pharmacy
Rite Aid Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Savon Pharmacy
Shoprite Pharmacy
Super Fresh Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
District of ColumbiaCare Plus/CVS Pharmacy
CVS Pharmacy
Costco Pharmacy
Giant Pharmacy
Harris Teeter Pharmacy
Rite Aid Pharmacy
Safeway Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
FloridaCare Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Navarro Discount Pharmacy
Publix Pharmacy
Sam’s Pharmacy
Savon Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Winn-Dixie Pharmacy
GeorgiaBi-Lo Pharmacy
Care Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Fred’s Pharmacy
Harveys Pharmacy
Ingles Pharmacy
Kmart Pharmacy
PHARMACY DIRECTORY
Kroger Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Publix Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Winn-Dixie Pharmacy
GuamKmart Pharmacy
HawaiiCare Plus/CVS Pharmacy
Costco Pharmacy
Kmart Pharmacy
Longs Drug Stores
Safeway Pharmacy
Sam’s Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
IdahoCostco Pharmacy
Fred Meyer Pharmacy
Kmart Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Ridleys Pharmacy
Rite Aid Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Savon Pharmacy
Shopko Pharmacy
Smith’s Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
IllinoisCostco Pharmacy
Cub Pharmacy
CVS Pharmacy
Doc’s Drugs
Fagen Pharmacy
Hartig Drug Company
Hy-Vee Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Meijer Pharmacy
Osco Drugs
Sam’s Pharmacy
Schnucks Pharmacy
Shopko Pharmacy
Shop N Save Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
IndianaCostco Pharmacy
CVS Pharmacy
Fagen Pharmacy
Fred’s Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Marsh Drugs
Martins Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Meijer Pharmacy
Osco Drugs
Rite Aid Pharmacy
Sam’s Pharmacy
Schnucks Pharmacy
Shopko Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
IowaCostco Pharmacy
CVS Pharmacy
Dahl’s Pharmacy
Hartig Drug Company
Hy-Vee Pharmacy
Kmart Pharmacy
Lewis Family Drug
Medicap Pharmacy
Medicine Shoppe Pharmacy
Osco Drugs
Sam’s Pharmacy
Schnucks Pharmacy
Shopko Pharmacy
Target Pharmacy
Thrifty-white Drug
Walgreens Pharmacy
Walmart Pharmacy
KansasCostco Pharmacy
CVS Pharmacy
Dillon Pharmacy
Hen House Pharmacy
Hy-Vee Pharmacy
Kmart Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Price Chopper Pharmacy
PHARMACY DIRECTORY
Sam’s Pharmacy
Shopko Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
KentuckyCostco Pharmacy
CVS Pharmacy
Food City Pharmacy
Fred’s Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Meijer Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Shopko Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
LouisianaAlbertson’s Pharmacy
Brookshire Brothers
Brookshire Pharmacy
CVS Pharmacy
Fred’s Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Savon Pharmacy
Super 1 Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Winn-Dixie Pharmacy
MaineCVS Pharmacy
Hannaford Brothers
Kmart Pharmacy
Medicine Shoppe Pharmacy
Rite Aid Pharmacy
Osco Pharmacy
Sam’s Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
MarylandCostco Pharmacy
CVS Pharmacy
Giant Eagle Pharmacy
PHARMACY DIRECTORY
Giant Pharmacy
Happy Harry’s
Klein’s Shoprite Pharmacy
Kmart Pharmacy
Martins Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Rite Aid Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Savon Pharmacy
Shoppers Pharmacy
ShopRite Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Wegmans Pharmacy
MassachusettsBig Y Pharmacy
Care Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Eaton Apothecary
Hannaford Brothers
Kmart Pharmacy
Medicine Shoppe Pharmacy
Osco Pharmacy
Price Chopper Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Stop & Shop Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Wegmans Pharmacy
MichiganCostco Pharmacy
CVS Pharmacy
Family Fare Pharmacy
Henry Ford Medical
Kmart Pharmacy
Knight Drug
Kroger Pharmacy
Martins Pharmacy
Meijer Pharmacy
Medicine Shoppe Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Snyder Drug
Shopko Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
MinnesotaCare Plus/CVS Pharmacy
Cash Wise Pharmacy
Coborn’s Pharmacy
Costco Pharmacy
Cub Pharmacy
CVS Pharmacy
Econofoods Pharmacy
Fairview Pharmacy
Hy-Vee Pharmacy
Kmart Pharmacy
Lewis Family Drug
Mayo Clinic Pharmacy
Medicine Shoppe Pharmacy
Park Nicollet Pharmacy
Sam’s Pharmacy
Shopko Pharmacy
Rainbow Foods Pharmacy
Rainbow Pharmacy
Target Pharmacy
Thrifty-white Drug
Walgreens Pharmacy
Walmart Pharmacy
MississippiCVS Pharmacy
Fred’s Pharmacy
Fred’s XPress Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Super D Drugs
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Winn-Dixie Pharmacy
MissouriCare Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Dierbergs Family Markets
Dillon Pharmacy
Family Pharmacy
Gerbes Pharmacy
Hy-Vee Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Price Chopper Pharmacy
Price Cutter Pharmacy
Sam’s Pharmacy
Schnucks Pharmacy
PHARMACY DIRECTORY
Shop ‘n Save Pharmacy
Super D Drugs
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
MontanaCostco Pharmacy
CVS Pharmacy
Kmart Pharmacy
Osco Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Shopko Pharmacy
Smith’s Pharmacy
Target Pharmacy
Walmart Pharmacy
NebraskaBakers Pharmacy
Costco Pharmacy
CVS Pharmacy
Hy-Vee Pharmacy
Kmart Pharmacy
Safeway Pharmacy
Shopko Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
NevadaCostco Pharmacy
CVS Pharmacy
Kmart Pharmacy
Medicine Shoppe Pharmacy
Raley’s Drug Centers
Rite Aid Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Savon Drugs
Scolari’s Food and Drug
Smith’s Pharmacy
Target Pharmacy
Von’s Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
New HampshireCostco Pharmacy
CVS Pharmacy
Hannaford Brothers
Kmart Pharmacy
Osco Pharmacy
Price Chopper Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
New JerseyA&P Pharmacy
Costco Pharmacy
CVS Pharmacy
Duane Reade
PHARMACY DIRECTORY
Genuardis Pharmacy
Happy Harry’s
Kmart Pharmacy
Medicine Shoppe Pharmacy
Medicap Pharmacy
Pathmark Pharmacy
Quick Chek Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Savon Pharmacy
ShopRite Pharmacy
Stop & Shop Pharmacy
Super Fresh Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Wegmans Pharmacy
Weis Pharmacy
New MexicoCostco Pharmacy
CVS Pharmacy
Kmart Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Savon Drugs
Smith’s Food & Drug
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
New YorkA&P Pharmacy
Care Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Drug World
Duane Reade
Gristedes Pharmacy
Hannaford Brothers
King Kullen Pharmacy
Kinney Drugs
Kmart Pharmacy
Medicine Shoppe Pharmacy
Pathmark Pharmacy
Price Chopper Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Shoprite Pharmacy
Stop & Shop Pharmacy
Target Pharmacy
Tops Pharmacy
Waldbaums Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Wegmans Pharmacy
Weis Pharmacy
North CarolinaBi-Lo Pharmacy
Care Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Food Lion Pharmacy
Harris Teeter Pharmacy
Ingles Pharmacy
Kerr Drug Stores
Kmart Pharmacy
Kroger Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
North DakotaCVS Pharmacy
Medicine Shoppe Pharmacy
Thrifty-white Drug
White Drugs
OhioACME Pharmacy
Costco Pharmacy
CVS Pharmacy
Discount Drug Marts
Fruth Pharmacy
Giant Eagle Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Marcs Pharmacy
Medicine Shoppe Pharmacy
Meijer Pharmacy
Rite Aid Pharmacy
Ritzman Pharmacy
Sam’s Pharmacy
Shopko Pharmacy
Target Pharmacy
Thrifty White Drugs
Walgreens Pharmacy
Walmart Pharmacy
OklahomaCVS Pharmacy
Drug Warehouse
Harps Pharmacy
Homeland Pharmacy
Kmart Pharmacy
May’s Drug Stores
Medicine Shoppe Pharmacy
PHARMACY DIRECTORY
Med-X-Drug
Reasors Pharmacy
Sam’s Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
OregonBi-Mart Pharmacy
Care Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Fred Meyer Pharmacy
Hi-School Pharmacy
Kmart Pharmacy
Medicine Shoppe Pharmacy
Rite Aid Pharmacy
Safeway Pharmacy
Savon Pharmacy
Shopko Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
PennsylvaniaCare Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Giant Eagle Pharmacy
Giant Pharmacy
Klingensmiths Pharmacy
Kmart Pharmacy
Medicap Pharmacy
Medicine Shoppe Pharmacy
Pathmark Pharmacy
Price Chopper Pharmacy
Rite Aid Pharmacy
Savon Pharmacy
ShopRite Pharmacy
Super Fresh Pharmacy
Target Pharmacy
Tops Markets
Walgreens Pharmacy
Walmart Pharmacy
Wegmans Pharmacy
Weis Pharmacy
Puerto RicoCare Plus/CVS Pharmacy
CVS Pharmacy
Kmart Pharmacy
Sam’s Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Rhode IslandCare Plus/CVS Pharmacy
CVS Pharmacy
Osco Pharmacy
Rite Aid Pharmacy
Stop & Shop Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
PHARMACY DIRECTORY
South CarolinaBi-Lo Pharmacy
Care Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Food Lion Pharmacy
Fred’s Pharmacy
Harris Teeter Pharmacy
Ingles Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Medicine Shoppe Pharmacy
Publix Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Target Pharmacy
Piggly Wiggly Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
South DakotaHy-Vee Pharmacy
Kmart Pharmacy
Lewis Family Drug/Lewis Drug
Safeway Pharmacy
Sam’s Pharmacy
Shopko Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
TennesseeBi-Lo Pharmacy
Care Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
Food City Pharmacy
Fred’s Pharmacy
Harris Teeter Pharmacy
Ingles Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Medicine Shoppe Pharmacy
Publix Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Schnucks Pharmacy
Super D Drugs
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
TexasAlbertson’s Pharmacy
Brookshire Brothers
Brookshire Grocery
Care Plus/CVS Pharmacy
Costco Pharmacy
CVS Pharmacy
H.E.B. Pharmacy
Kmart Pharmacy
Lifechek Pharmacy
Kroger Pharmacy
Medicine Shoppe Pharmacy
Minyard Pharmacy
Randalls Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Savon Pharmacy
Smith’s Food & Drug
Super 1 Pharmacy
Target Pharmacy
Tom Thumb Pharmacy
United Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
U.S. Virgin IslandsKmart Pharmacy
Medicine Shoppe Pharmacy
Walgreens Pharmacy
UtahCity Market Pharmacy
Costco Pharmacy
Fresh Market Pharmacy
Harmons Pharmacy
Kmart Pharmacy
Medicine Shoppe Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Savon Pharmacy
Shopko Pharmacy
Smith’s Food & Drug
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
VermontCostco Pharmacy
CVS Pharmacy
Hannaford Brothers
Kinney Drugs
Osco Pharmacy
Price Chopper Pharmacy
Rite Aid Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
VirginiaCostco Pharmacy
CVS Pharmacy
PHARMACY DIRECTORY
“Cigna” and the “Tree of Life“ logo are registered service marks, and “Together, all the way.” 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 by or through such operating subsidiaries, including Connecticut General Life Insurance Company and Cigna Health and Life Insurance Company, and not by Cigna Corporation. All models are used for illustrative purposes only.
589901 l 01/15 © 2015 Cigna. Some content provided under license.
PHARMACY DIRECTORYFarm Fresh Pharmacy
Food City Pharmacy
Food Lion Pharmacy
Giant Pharmacy
Harris Teeter Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Martins Pharmacy
Medicine Shoppe Pharmacy
Rite Aid Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Shoppers Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
WashingtonBartell Drugs
Bi-Mart Pharmacy
Care Plus/CVS Pharmacy
Costco Pharmacy
Food Pavilion Pharmacy
Fred Meyer Pharmacy
Haggen Food & Pharmacy
Hi-School Pharmacy
Kmart Pharmacy
Medicine Shoppe Pharmacy
QFC Pharmacy
Rite Aid Pharmacy
Rosauers Pharmacy
Safeway Pharmacy
Sam’s Pharmacy
Savon Pharmacy
Shopko Pharmacy
Target Pharmacy
Top Foods Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Yokes Pharmacy
West VirginiaCVS Pharmacy
Fruth Pharmacy
Giant Eagle Pharmacy
Kmart Pharmacy
Kroger Pharmacy
Martins Pharmacy
Medicine Shoppe Pharmacy
Medicap Pharmacy
Rite Aid Pharmacy
Sam’s Pharmacy
Target Pharmacy
Walgreens Pharmacy
Walmart Pharmacy
Weis Pharmacy
WisconsinAurora Pharmacy
Costco Pharmacy
Copps Food Center Pharmacy
CVS Pharmacy
Hartig Drug Company
Hy-Vee Pharmacy
Kmart Pharmacy
Marshfield Clinic Pharmacy
Mayo Clinic Pharmacy
Medicine Shoppe Pharmacy
Pick N Save Pharmacy
Sam’s Pharmacy
Schnucks Pharmacy
Shopko Pharmacy
Target Pharmacy
Thrifty-white Drug
Walgreens Pharmacy
Walmart Pharmacy
WyomingCity Market Pharmacy
King Sooper’s Pharmacy
Kmart Pharmacy
Safeway Pharmacy
Shopko Pharmacy
Smith’s Food & Drug
Walgreens Pharmacy
Walmart Pharmacy
Osco Pharmacy
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