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Cigna update package
1. Rocky Mountain UFCW Union &
Employers Health Benefit Plan
Four-Tier Plan
2012 Cigna
prescription
drug list
This list is designed to cover your prescription medications at four levels.
The amount you will pay will depend on the tier from which you and your
doctor select your medication. If there is more than one drug appropriate
for your condition, we encourage you to talk to your doctor about low cost
medications like generics and preferred brands, as they will help to manage
your prescription costs better.
853379 02/12 Value PDL
2. 1st Tier – Generic Medications: Generic drugs have the same active
ingredients, safety, dosage, quality and strength, as their brand-name counterparts.
You will usually pay less for generic medications under your plan.
2nd Tier – Preferred Brand Medications: Preferred brand drugs will
usually cost you more than a generic, but less than a non-preferred brand drug
under your plan.
3rd Tier – Non-Preferred Brand Medications:
Non-preferred brand drugs are those that generally have generic alternatives
and/or one or more preferred brand options within the same drug class. You will
usually pay more for a non-preferred brand under your plan.
4th Tier – Specialty Medications: Specialty Injectable Medications are
typically covered under the fourth tier and include, but are not limited to,
injectables used to treat arthritis, multiple sclerosis, hepatitis C, and asthma. See
the list of Specialty medications on page 22.
Understanding the
Cigna Prescription Drug List
Every medication available on the drug list has been approved by the
U.S. Food and Drug Administration (FDA). This list represents the most
commonly prescribed medications. Please reference Cigna.com or myCigna.
com for the complete up-to-date listing of medications. Refer to your
enrollment information to find out which specific medications are covered
under your plan.
The symbols on the list mean …
If your medication has one of the following symbols, your doctor may have to
get an authorization for coverage.
PA: Prior Authorization may be required for different reasons.
To learn the requirements needed for coverage of a specific
medication, please 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 may 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.
2
3. Important Note
This list does not cover drugs that have over-the-counter (OTC) alternatives,
drugs that treat stomach acid conditions and non-sedating antihistamines to
treat allergies.
In some cases medications for certain conditions (allergies, heartburn/ulcers, etc.)
may be equivalent products to OTC medications available. In these cases, the
prescription available class alternatives are excluded from coverage. Examples*
include allergy medications such as Allegra, Clarinex, Xyzal and any generics; and
heartburn/ulcer medications such as Nexium, Prilosec, Zantac and any generics.
(*Examples not all-inclusive listing).
Help From myCigna.com
When you go to myCigna.com you can:
• Compare actual medication prices at local pharmacies
• See your specific pharmacy coverage information
• Research available medications and network pharmacies
• Ask a pharmacist questions
If You Have Any Questions
Feel free to give us a call at the number on the back of your ID Card.
We’re here to help.
3
23. excLUSioNS & LiMiTaTioNS
Plans typically do not provide coverage for the following, except as required by law or by the
terms of your specific plan:
1. Any medications available over the 6. Any prescription and non-prescription
counter that do not require a prescription supplies (such as ostomy supplies),
by Federal or State Law, and any devices, and appliances.
medication that is a pharmaceutical 7. Any contraceptive medications and
alternative to an over the counter prescription appliances for contraception.
medication other than insulin. 8. Implantable contraceptive products.
[examples include OTC Benadryl, Maalox,
9. Any fertility medication.
Sudafed PE , etc.]
10. Any medications used for treatment of
2. Medications that are therapeutically
sexual dysfunction, including but not
equivalent as determined by the Cigna
limited to erectile dysfunction, delayed
HealthCare Pharmacy and Therapeutics
ejaculation, anorgasmia and decreased
Committee in which at least one of the
libido.
medications within the class is available
over the counter. [examples include Rx 11. Any prescription vitamins (other than
equivalents to OTC Allegra, Claritin and prenatal vitamins), dietary supplements
Zyrtec (Allegra D, Clarinex, Xyzal) and and fluoride products.
Rx equivalents to OTC Prevacid, Prilosec, 12. Medications used for cosmetic purposes,
Zantac (Aciphex, Kapidex, Nexium, Axid, such as medications used to reduce
Pepcid, Zantac)] wrinkles, medications to promote hair
3. Any injectable infertility medications, and growth, medications used to control
any injectable medications that require perspiration and fade cream products.
Health Care Professional supervision 13. Any diet pills or appetite suppressants
and are not typically considered self- (anorectics).
administered medications. The following 14. Prescription smoking cessation products.
are examples of Health Care Professional- 15. Immunization agents, biological products
supervised medications: Injectables used for allergy immunization, biological sera,
to treat hemophilia and RSV (respiratory blood, blood plasma and other blood
syncytial virus), chemotherapy injectables, products or fractions and medications
and endocrine and metabolic agents. used for travel prophylaxis.
4. Any medications that are experimental or 16. Replacement of prescription medications
investigational, within the meaning set and related supplies due to loss or theft.
forth in the summary plan description. 17. Medications used to enhance athletic
5. Food and Drug Administration (FDA)- performance.
approved medications used for purposes 18. Medications that are to be taken by
other than those approved by the FDA or administered to a Customer while
unless the medication is recognized the Customer is a patient in a licensed
for the treatment of the particular hospital, skilled nursing facility, rest home
indication in one of the standard or similar institution which operates on
reference compendia (The United States its premises or allows to be operated
Pharmacopoeia Drug Information or The on its premises a facility for dispensing
American Hospital Formulary Service pharmaceuticals.
Drug Information) or in medical literature.
19. Prescriptions more than one year from the
Medical literature means scientific studies
original date of issue.
published in a peer-reviewed national
professional medical journal.
23
25. Get a dose of healthy savings
with the CIGNA Value Prescription Drug List
Now more than ever, you Consider the following two unique
need to lower your benefit characteristics that drive the savings:
plan costs. It’s important
to balance this need with Distinctive Tier Design
The Value PDL encourages people to choose low-cost generic
employee satisfaction
medications by placing most brand name drugs on the higher cost
by continuing to offer third tier. Also, a much-smaller second tier offers only the drugs that
a complete pharmacy do not have a generic equivalent or a therapeutic alternative.
program. CIGNA’s Value
Prescription Drug List Effective Exclusions
Certain exclusions are responsible for approximately half the savings
(PDL) helps you do both.
available with the Value PDL. These include all medications that
With the Value PDL, have an over-the-counter (OTC) equivalent or therapeutic alternative;
specifically, non-sedating antihistamines (allergy medications) along
you’ll see savings of
with PPIs and H2 blockers (ulcer/heartburn medications). Lifestyle
up to 25% on pharmacy drugs, including weight loss, infertility, smoking cessation and
claim costs. That’s erectile dysfunction medications, are also excluded.
significant — especially
Speak to your CIGNA sales representative to enjoy all
when you consider the benefits of the CIGNA Value Prescription Drug List
that this translates to — coming this May.
approximately 3% of your
overall medical costs.
“CIGNA”,“CIGNA.com”,“myCIGNA.com”and the ”Tree of Life”logo are registered service marks, and ”CIGNA Home Delivery Pharmacy”is a service mark, of CIGNA Intellectual
Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries
and not by CIGNA Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, CIGNA Health and Life Insurance Company,
Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. “CIGNA Home Delivery Pharmacy”
840505 02/11 Value PDL refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. All models are used for illustrative purposes only.