Under any Cigna plan option, you pay a percentage of the cost (or co-insurance) for preferred and non-preferred brand medication filled at a retail pharmacy. For generic prescriptions or those ordered through the Mail Order program, you just pay a flat copay. Preventive generics ordered through the Home Delivery Pharmacy are covered 100%. Application of prescription drug copays and co-insurance toward deductibles and out-of-pocket maximums varies depending on the plan selected.
Prescription Drug Coverage
Your prescription coverage will differ depending on which of the Cigna Plans you are enrolled in:
Health Savings Account (HSA) Plan: Your prescriptions are subject to the deductible first and then your out-of-pocket maximum. There is one exception to this: If you fill a generic preventive prescription NortonLifelock will cover this at 100% at both retail and Mail Order.
Open Access Plus (OAP) and OAP 500 Arizona Plans: You pay a percentage (co-insurance) of the cost for preferred and non-preferred brand medication filled at a retail pharmacy. For generic prescriptions and those ordered through Mail Order, you pay a flat copay. Preventive generics are covered at a retail pharmacy and Mail Order at 100%. Your plan’s deductible does not need to be met before co-insurance is applied. Your pharmacy charges will count toward your out-of-pocket maximum.
Regardless of which Cigna medical plan you are enrolled in, you’ll be required to fill your maintenance medications in a 90-day supply using the Cigna 90 Now Home Delivery program or at an in-network retail pharmacy.
* Number of days supplied may vary depending on the Specialty Drug List.
For detailed information about your prescription drug benefits and costs, review the 2022 Benefit Plans Comparison Chart.
Preferred Drug List (Formulary)
The Preferred Drug List, or Formulary (pdf) is a list of medications selected by Cigna insurance plans in consultation with a team of health care providers. The Plans will generally cover the drugs listed in the Preferred Drug List as long as the drug is medically necessary and plan rules are followed.
Key things to know about the Formulary:
- The Formulary is subject to change and is typically updated and posted between October and December every year.
- Drugs that appear on a Preferred Drug List have been chosen on the basis of sound medical data, safety and cost. Both brand-name and generic medications are on Cigna's Preferred Drug List and have been approved by the Food and Drug Administration (FDA) as safe and effective.
- If your current drug is not on Cigna's Preferred Drug List, consider speaking to your prescribing physician about alternative drugs that are on the list.
- Certain prescription drugs are excluded. For example, Renova, Vaniqa, Rogaine and over-the-counter drugs are excluded entirely. Botox, myobloc, immunization agents, certain contraceptive devices and nutritional/dietary supplements are generally excluded but may be covered under the medical plan. If you have questions about whether a prescription drug is covered, contact Cigna One Guide at 1-800-997-1654.
- Dispense-as-written (DAW) requirement: If your doctor writes a brand-name prescription when a generic equivalent is available, you will pay the regular copay plus the difference in cost between the brand-name and generic drug. To obtain an exception, your doctor must contact Cigna to explain why a generic equivalent isn’t acceptable.
Preventive Generic Prescriptions
Preventive generics are covered at a retail pharmacy and Mail Order at 100%. Regardless of which Cigna medical plan you are enrolled in, you’ll be required to fill your maintenance medications in a 90-day supply using Cigna 90 Now Home Delivery program or at an in-network retail pharmacy.
Certain drugs require pre-certification prior to being filled. Pre-certification is designed to help encourage appropriate use of certain drugs in accordance with current medical findings, FDA-approved manufacturer labeling information, and cost and manufacturer rebate arrangements. The pre-certification list consists of drugs identified as having a narrowly defined use, as being more likely to be taken inappropriately or for too long a time period, or as being more expensive than other drugs that have been shown to be clinically or therapeutically similar. The pre-certification list is subject to change.
Cigna plan participants will have certain specialty medication prescriptions managed by Accredo, Cigna's specialty pharmacy for Express Scripts, which will help you better manage any out-of-pocket costs. Check to see if a prescription considered a specialty drug.
Step Therapy Prescription Management Program
All Cigna participants are subject to the Step Therapy Program. The purpose of the program is to encourage you and your physician to choose the most cost-effective, clinically appropriate medication as your first option before other more costly prescription medication options are considered.
The three steps of the Step Therapy program are:
- Step 1. Generic medication
- Step 2. Preferred brand medication
- Step 3. Non-preferred brand medication
The class of medications covered by the Step Therapy program include those used to treat several common medical conditions:
- Bladder problems
- Cholesterol lowering
- High Blood Pressure
- Mental Health
- Narcotic Pain Relievers
- Non-narcotic Pain Relievers
- Skin Conditions
- Sleep Disorders
The Diabetes Care and Pulmonary Care programs help to close gaps in care and reduce costs. Patients with diabetes or pulmonary conditions can fill 90-day prescriptions through Accredo, Cigna’s specialty pharmacy or at an in-network retail pharmacy.
Both programs provide access to:
- A team of specialist pharmacists
- A preferred quality pharmacy network
- Clinical programs, such as remote monitoring
Filling and Refilling Prescriptions
Your prescription drug plan offers services to make obtaining your prescriptions more convenient and inexpensive, depending on your circumstances.
Whether you are viewing myCigna.com or using the MyCigna mobile app, you can easily manage your prescriptions:
- Check order status
- Refill and renew prescriptions
- Check prices and coverage
- Find convenient pharmacies
- View your Rx claims and balances
- Pay your balance using a variety of payment options
- View our therapeutic resource center for information
To access the member website…
Log in to www.mycigna.com. (Complete registration if this is your first visit).