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Choosing the medication that is right for you
offer an extensive list of brand and generic
Choosing where to fill your medication should
be easy, too. With over 60,000 pharmacies
network, you will have convenient access to your
medications – whether you pick them up, or
Enclosed you will find a list of medications
covered by your plan, in an easy-to-read format.
1. Medications listed in categories (generic and
2. Health conditions and medications listed in
3. Symbols to let you know if there are any
Drug PlanA two-tier prescription drug plan splits
medications into two categories or tiers:
1st Tier – Generic medications:
have the same active ingredients, safety, dosage,
quality and strength as their brand-name
counterparts. You will typically pay less for generic
medications under a two-tier plan.2nd Tier – Brand medications:
Brand medications are
sold under a brand name given by the manufacturer.
Not al brand-name medications have a generic
alternative available. You wil typical y pay more for
brand-name medications under a two-tier plan.
Preventive Prescription Drug OptionPreventive medications are prescribed to prevent the occurrence of a disease or condition with risk factors such as: high blood pressure, high cholesterol, diabetes, asthma, osteoporosis, heart attack and stroke, or to prevent the recurrence of the disease or condition for individuals who have recovered. Preventive medications do not include drugs used to treat an existing illness, injury or condition.
For some pharmacy plans that require you to pay
a certain amount before the plan coverage begins,
preventive medications may be covered before
you reach that amount. To be sure, you should read
your enrollment information to see how preventive
medications are covered specific to your plan.
Also, a list of all covered preventive medications is
available on CIGNA.com
. Preventive medications
are identified by a “PM” symbol within the drug list
prescription drug list has been approved
by the U.S. Food and Drug Administration
(FDA). This list represents the most commonly
If you do not see a specific medication on
this list, please check CIGNA.com
. Go to the
“Resources for Members” page, and click
“Drug Lists” for the most up-to-date list of
Refer to your enrollment information to find
out which specific medications are covered
The symbols on the list mean .
If your medication has one of the following
authorization for coverage of that medication.
PA: Prior Authorization
may be required for
different reasons. To learn the requirements
medication, feel free to give us a call.
QL: Quantity Limit
means you may have
coverage for a limited amount of a specific
AGE: Age Requirement
means an individual
must be within a specific age group for a
ST: Step Therapy
is a prior authorization
condition before the “ST” medication is
a tool to help you
manage your prescription benefits:
When you go to the Pharmacy page of myCIGNA.com
Look up your specific pharmacy coverage;
Research thousands of available medications;
Find the actual amounts you will pay for specific
Compare medication prices using the
Ask a pharmacist questions;
Download forms; and more.
Medications Delivered to Your HomeCIGNA Home Delivery Pharmacy is designed for
individuals who take prescription medications on
a regular basis (including Specialty medications).
The benefits of CIGNA Home Delivery Pharmacy
Up to a 90-day supply of your medications
Delivery of medications to your home at no
Licensed pharmacists available to help 24/7
CoachRx: a free tool that is available if you use
CIGNA Home Delivery Pharmacy. It can help with
reminders, coupons and information about your
prescriptions. Visit CIGNA.com/coachrx
To get an order form, you can go to the Pharmacy
page on myCIGNA.com
or call 1.800.835.3784,
To order a specialty medication, visit CIGNA.com
and click “Resources for Members.” You will see the
“Specialty Pharmacy” page where the specialty
medication order form is located. You can also call
1.800.351.3606 to talk with someone directly.
Health Care Reform and YouThe Patient Protection and Affordable Care Act
(PPACA), commonly referred to as “health care
reform”, was signed into law on March 23, 2010. This
important legislation will result in changes to every
American’s health coverage. Some of the changes
are taking effect in 2010 and most of the law’s effects
CIGNA will comply with all provisions of the law
including those that impact your pharmacy coverage
plan. For example, depending upon the final
government regulations, coverage for medications
that have not traditionally been included in
pharmacy plans, such as specific over-the-counter
(OTC) medications, may be made available at no
cost share to you. As with all covered medications,
we would require a prescription from your doctor
to process the claim under your pharmacy plan
To get the most current information visit
and look for the “Informed on Reform” link.
If You Have QuestionsFeel free to call us at the toll-free number on the
back of your CIGNA ID card. We’re here to help.
* Please check your enrollment materials to determine whether these
medications are covered under your specific plan.
HIGH BLOOd PressUre/HeArT MedICATIONs
HIGH BLOOd PressUre/HeArT MedICATIONs
HOrMONe rePLACeMeNT (CONTINUED)
NAUseA ANd VOMITING
PAIN reLIeF & INFLAMMATOrY dIseAse
exCLUsIONs & LIMITATIONs
Plans typical y do not provide coverage for the fol owing, except as required by law or
1. Any medications available over-the-counter that do not require a prescription by
Federal or State Law, and any medication that is a pharmaceutical alternative to
an over-the-counter medication other than insulin.
2. Medications that are therapeutical y equivalent as determined by the CIGNA
HealthCare Pharmacy and Therapeutics Commit ee in which at least one of the
medications within the class is available over-the-counter.
3. Any injectable infertility medications, and any injectable medications that
require Health Care Professional supervision and are not typical y considered
self-administered medications. The fol owing are examples of Health Care
Professional supervised medications: Injectables used to treat hemophilia and
RSV (respiratory syncytial virus), chemotherapy injectables, and endocrine and
4. Any medications that are experimental or investigational, within the meaning
set forth in the summary plan description.
5. Food and Drug Administration (FDA) approved medications used for purposes
other than those approved by the FDA unless the medication is recognized
for the treatment of the particular indication in one of the standard reference
compendia (The United States Pharmacopoeia Drug Information or The
American Hospital Formulary Service Drug Information) or in medical literature.
Medical literature means scientific studies published in a peer-reviewed national
6. Any prescription and non-prescription supplies (such as ostomy supplies),
7. Any contraceptive medications and prescription appliances for contraception. 8. Implantable contraceptive products. 9. Any fertility medication. 10. Any medications used for treatment of sexual dysfunction, including but
not limited to erectile dysfunction, delayed ejaculation, anorgasmia and
11. Any prescription vitamins (other than prenatal vitamins), dietary supplements
12. Medications used for cosmetic purposes, such as medications used to reduce
wrinkles, medications to promote hair growth, medications used to control
13. Any diet pil s or appetite suppressants (anorectics). 14. Prescription smoking cessation products. 15. Immunization agents, biological products for al ergy immunization, biological
sera, blood, blood plasma and other blood products or fractions and medications
16. Replacement of prescription medications and related supplies due to loss or
17. Medications used to enhance athletic performance. 18. Medications which are to be taken by or administered to a Customer while the
Customer is a patient in a licensed hospital, skil ed nursing facility, rest home or
similar institution which operates on its premises or al ows to be operated on its
premises a facility for dispensing pharmaceuticals.
19. Prescriptions more than one year from the original date of issue.
CIGNA reserves the right to make changes to this 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 prescriber or pharmacist. CIGNA may receive payments from manufacturers of certain Preferred Brand medications, and in limited instances, certain Non-Preferred Brand medications, which 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.
“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” refers to Tel-Drug, Inc. and Tel-Drug
NOM SCIENTIFIQUE Rudbeckia deamii. Rudbeckia laciniata. Echinacea purpurea. NOM COMMUN La famille des Asteraceae, aussi connue sous l’ancien nom de Compositae, est l’une des plus importantes chez les végétaux Il s’agit de plantes, le plus souvent herbacées, possédant des inflorescences en capitule (type pissenlit). Un capitule n’est pas une fleur, mais un ensembl
Department of State Health Services, Immunization Branch Screening Questionnaire for Intranasal 2009 H1N1 Influenza Vaccine 1. Is the person to be vaccinated younger than 2 years of age or older than 49 years of age? If YES, person is not eligible for Intranasal Influenza vaccine. Please consider injectable influenza vaccine. 2. Have you read the vaccine information statement(s) for th