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SPECIALTY DRUG LISTStarting July 1, 2020Specialty medications are used to treat complex medical conditions like multiple sclerosis,hepatitis C and rheumatoid arthritis.About this drug list.This document shows the most commonly prescribedoral and injectable specialty medications coveredas of July 1, 2020.1,2 All of these medications areapproved by the U.S. Food and Drug Administration(FDA). Medications are listed alphabetically; Brandname medications are capitalized and genericmedications are lowercase. The Specialty Drug Listis updated often so it’s important to know that thisis not a complete list of the medications your plancovers. Also, your specific plan may not cover all of themedications in this document.Some plans have specific coverage requirementsfor specialty medications.These medications have an asterisk (*) next to them.Why does this matter? Because the benefit yourmedication is covered under may:– Affect the amount you pay for it.– Mean you need approval from Cigna before yourplan will cover it.– Require you to use a specific pharmacy toreceive coverage.For example, if your medication is covered under thepharmacy benefit, you may have to use Accredo, aCigna specialty pharmacy, to receive coverage.3 If it’scovered under the medical benefit and you’re gettingit from your health care provider, you may not haveto use Accredo.For example, your plan may:››Limit coverage to a 30-day supply.Cover certain medications under the pharmacybenefit, medical benefit, or under both benefits.Log in to the myCigna App or website, or check your plan materials, to learn more about the specialtymedications your plan covers. You can also click on “Price a Medication” to see how much your medicationmay cost you.4Offered by: Cigna Health and Life Insurance Company or Connecticut General Life Insurance Company.939996 Specialty FACETS 07/20
Medication relACTIMMUNE*AdakveoAdcetrisAdcirca*adefovir dipivoxil*Adempas*AdriamycinAdrucilAdvate*Advate 3,601-4,800 unitAdynovate*Afinitor*Afinitor DisperzAfstyla*ALDURAZYME*Alecensa*Alferon e *aminocaproic acid*Ampyra*AmviscAndexxaApokyn*AptivusAralast /50ml-0.9% NaClvial*ArikayceArixtraArranonarsenic trioxideArzerraAscenivAscleraAsparlasAstagraf eedAvonex*azacitidineAzasan*azathioprine tablet*Azedra DosimetricAzedra TherapeuticBoniva syringe*bortezomibbosentan*Bosulif*Botox 100 unit vialBotox 200 unit vial*Botox t capsule,suspension, tablet*CellCept lbamchorionic xone*BBalversaBaraclude*BavencioBCG Vaccine (Tice ix*Benlysta 200mg/ml*Benlysta capsule*cyclophosphamide vialcyclosporine ampulecyclosporine capsule*cyclosporine inomycinDalfampridine ER*DaraprimDarzalex*daunorubicinDaurismo*DDAVP ampule, escovydesmopressin ampule, l 160mg/8ml vial*Doptelet*DovatoDoxildoxorubicinDSUVIABrand name medications are capitalized and generic medications are lowercase.* Your plan may require you to fill this medication through Accredo, a Cigna specialty pharmacy, to receive coverage. You may be able to use an in-network retail pharmacy one or more times beforeswitching to Accredo. Log in to the myCigna app or website, or check your plan materials, to learn more about how your plan covers this medication.2
Medication ia*EyleaEFabrazyme*FARYDAK*Fasenra*FaslodexFeiba amma DIFFlolanfloxuridinefludarabinefluorouracil vialFollistim lvestrantFuzeon*EdurantefavirenzEgrifta*Egrifta U*enoxaparinentecavir*Entyvio*Envarsus XR*Epclusa*Epidiolex*epirubicinEpivirEpivir setoposide capsule*etoposide emlibra*Hemofil M*Hepagam enex*Hymovis*HyperHEP B S-DHyperRABHyperRHO S-DHyQviaGGalafold*GamaStan*Gamastan S-D*GamifantGammagard*Gammagard *Genotropin*Genvisc 850*GenvoyaGiaprezaGilenya*Iibandronate syringe, matinib*ImbruvicaIMFINZIIMLYGICImogam *IngrezzaInlyta*Inrebic*IntelenceIntron A*InviraseIressa*irinotecanIsentressIsentress HDIstodaxIXEMPRAIxinity*JJadenu*Jadenu Jynarque 45mg-15mg,60mg-30mg, 90-30mgJynarque 15mg, eretKisqali*Kisqali Femara Co-Pack*Kitabis Pak*Koate*Kogenate FS*Brand name medications are capitalized and generic medications are lowercase.* Your plan may require you to fill this medication through Accredo, a Cigna specialty pharmacy, to receive coverage. You may be able to use an in-network retail pharmacy one or more times beforeswitching to Accredo. Log in to the myCigna app or website, or check your plan materials, to learn more about how your plan covers this medication.3
Medication prolis 10mg, 60mg vialKyprolis 30mg vial*Llamivudinelamivudine sLumizymeLumoxiti vialLupaneta Pack*Lupron ayzent 0.25mg starterpackMayzent 0.25mg, mesnaMesnexMICRhoGAM mycinMvasiMyalept*mycophenolate capsule,suspension, tablet*mycophenolate vialmycophenolic ven RT*NplateNubeqa*Nucala*NulojixNuplazid*Nutropin AQ *Orenitram *Nerlynx*Neulasta syringeNeulasta Onpro Kit*Neupogennevirapinenevirapine ro*NipentnitisinoneNityrNivestymNorditropin nate*PanhematinPanretin*PanzygaParagard T 380-Aparicalcitol capsule*paricalcitol rtrazzaPoteligeoPraxbindPregnylPrevymis tablet*Prevymis i*Profilnine*progesterone vial*Prograf ampulePrograf capsule, granulepacket*Prolastin PurixanRRadicavaRapamune*Ravicti*Rebif*Rebif Revatio*Brand name medications are capitalized and generic medications are lowercase.* Your plan may require you to fill this medication through Accredo, a Cigna specialty pharmacy, to receive coverage. You may be able to use an in-network retail pharmacy one or more times beforeswitching to Accredo. Log in to the myCigna app or website, or check your plan materials, to learn more about how your plan covers this medication.4
Medication NameRevcoviRevlimid*ReyatazRhoGAM k*riluzole*Rinvoq andimmune ampuleSandimmune stim*Signifor*Signifor LAR*sildenafil suspension,20mg tablet, vial*Siliq*Simponi*Simponi Aria*SimulectSinuvasirolimus*SirturoSkylasodium hyaluronatesodium uline locadeSucraidSupartz FX*Supprelin I e*Syprine*Ttacrolimus capsule*tadalafil Tecfidera*Tegsedi*TemixysTemodar capsule*Temodar padinatetrabenazine*Thalomid*ThiolaThiola ECthiotepaThrombate *TOBI Podhaler*tobramycin ampule*Toposartopotecan*ToriselTracleer*tranexamic inUptravi*Wilate*WinRho SDF*Valchlor*valrubicinValstarVantas*Varithena injectable is*Verzenio*VidazaVidexVidex ECViekira inevinorelbineViraceptViramuneViramune rand name medications are capitalized and generic medications are lowercase.* Your plan may require you to fill this medication through Accredo, a Cigna specialty pharmacy, to receive coverage. You may be able to use an in-network retail pharmacy one or more times beforeswitching to Accredo. Log in to the myCigna app or website, or check your plan materials, to learn more about how your plan covers this medication.5
Medication NameXXalkori*Xeljanz*Xeljanz XR 11mg*Xeljanz XR arxio*Zavesca*ZejulaZelboraf*ZemairaZemplar capsule*Zemplar qZZALTRAPZanosarZirabevZoladex*zoledronic ulressoZydelig*Zykadia*Zytiga*Brand name medications are capitalized and generic medications are lowercase.* Your plan may require you to fill this medication through Accredo, a Cigna specialty pharmacy, to receive coverage. You may be able to use an in-network retail pharmacy one or more times beforeswitching to Accredo. Log in to the myCigna app or website, or check your plan materials, to learn more about how your plan covers this medication.Choose Accredo, a Cigna specialty pharmacy. They’ll deliver specialty medications to yourdoor – and extra support to you.Whether you’ve been going through treatment for years or just got diagnosed, managing acomplex medical condition isn’t easy. If you need help, you can always call Accredo, a Cignaspecialty pharmacy. Accredo’s team of specialty-trained pharmacists and nurses can provideyou with the personalized care and support you need to manage your therapy – at no extra cost.They’ll also fill and ship your specialty medication to your home (or location of your choice).5,6›Personalized care. Accredo provides a wide range of personalized care services, includingcounseling and training on how to administer your medication.›24/7 access to specialty-trained pharmacists and nurses experienced in complex conditionsthat require specialty medications.›Fast shipping, at no extra cost. Accredo will schedule and quickly ship your medications(at no extra cost to you) – even those that need special handling, like refrigeration.›Easy refills and free reminders. Accredo will send you refill reminders to help make sure youdon’t miss a dose. You can refill certain prescriptions by text.7››Track your orders.8 Get real-time updates once Accredo ships your order.Copay assistance coordination and other options if you need help paying for your medication.To learn more about Accredo, go to Cigna.com/specialty. To get started using Accredo, call877.825.7657. They’ll take care of everything for you. Representatives are available Monday–Friday,7:00 am–10:00 pm CST and on Saturdays, 7:00 am–4:00 pm CST. Be sure to call Accredo about twoweeks before your next refill so they have time to get a new prescription from your doctor’s office.6
1. State laws in Texas and Louisiana may require your plan to cover your medication at your current benefit level until your plan renews. This means that if your medication is taken off the drug list,is moved to a higher cost-share tier or needs approval from Cigna before your plan will cover it, these changes may not begin until your plan’s renewal date. To find out if these state laws applyto your plan, please call Customer Service using the number on your Cigna ID card.2. State law in Illinois may require your plan to cover your medications at your current benefit level until your plan renews. This means that if you currently have approval through a review processfor your plan to cover your medication, the drug list change(s) listed here may not affect you until your plan renewal date. If you don’t currently have approval through a coverage review process,you may continue to receive coverage at your current benefit level if your doctor requests it. To find out if this state law applies to your plan, please call Customer Service using the number onyour Cigna ID card.3. Not all plans offer Accredo as a covered pharmacy option. Please log in to the myCigna app or website, or check your plan materials, to learn more about the pharmacies in your plan’s network.4. Prices shown on myCigna are not guaranteed and coverage is subject to your plan terms and conditions. Visit myCigna for more information.5. As allowable by law.6. For medications administered by a health care provider, Accredo will ship the medication directly to your doctor’s office.7. The ability to refill prescriptions by text is only available for certain medications. To get text messages, you’ll have to sign up for Accredo’s texting service. You can do this when you call Accredoto refill your prescription. Once you sign up, simply reply to their welcome text to get started. Standard text messaging rates apply.8. You’ll see your first order in the myCigna App or website once Accredo ships it.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 takeresponsibility 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 towhich 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 medicationwithin its class for you and/or your plan.Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased froma 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 theprescription. 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 ordeductible requirements. Certain features described in this document may not be applicable to your specific health plan, and plan features may vary by location and plan type. Refer to your plandocuments 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 LifeInsurance Company, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., Accredo Health Group, Inc., and Express Scripts, Inc. “Accredo” refers to Accredo Health Group, Inc.939996 Specialty FACETS 07/20 2020 Cigna. Some content provided under license.
DISCRIMINATION IS AGAINST THE LAWMedical coverageCigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race,color, national origin, age, disability, or sex. Cigna does not exclude people or treat them differentlybecause of race, color, national origin, age, disability, or sex.Cigna: Provides free aids and services to people with disabilities to communicate effectively with us,such as:– Qualified sign language interpreters– Written information in other formats (large print, audio, accessible electronic formats,other formats) Provides free language services to people whose primary language is not English, such as:– Qualified interpreters– Information written in other languagesIf you need these services, contact customer service at the toll-free number shown on your ID card, andask a Customer Service Associate for assistance.If you believe that Cigna has failed to provide these services or discriminated in another way on thebasis of race, color, national origin, age, disability, or sex, you can file a grievance by sending an emailto ACAGrievance@Cigna.com or by writing to the following address:CignaNondiscrimination Complaint CoordinatorPO Box 188016Chattanooga, TN 37422If you need assistance filing a written grievance, please call the number on the back of your ID cardor send an email to ACAGrievance@Cigna.com. You can also file a civil rights complaint with theU.S. Department of Health and Human Services, Office for Civil Rights electronically through theOffice for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf,or by mail or phone at:U.S. Department of Health and Human Services200 Independence Avenue, SWRoom 509F, HHH BuildingWashington, DC 202011.800.368.1019, 800.537.7697 (TDD)Complaint forms are available l Cigna products and services are provided exclusively by or through operating subsidiaries of CignaCorporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company,Cigna Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries ofCigna Health Corporation and Cigna Dental Health, Inc. The Cigna name
Faslodex Feiba NF* Ferriprox Fibryga Firazyr* Firdapse Firmagon* Flebogamma DIF Flolan floxuridine fludarabine fluorouracil vial Follistim AQ Folotyn fondaparinux Forteo* fosamprenavir Fragmin fulvestrant Fuzeon* G Galafold* GamaStan* Gamastan S-D* Gamifant Gammagard* Gammagard S-D* Gammak
