Prescription Drug Coverage

Prescription Drug Coverage

If you enroll in a medical plan, you’re automatically enrolled in the Prescription Drug Program and your medical ID card issued is for prescriptions, too. The Prescription Drug Program does not have a deductible that you are required to meet, so your coverage begins with your first prescription.

There are two ways to get your prescriptions filled:

1) at a network retail pharmacy or
2) through mail order


The table shows how much you pay for each prescription, depending on the type of prescription drug you buy and how you fill it. Click on image for larger display.

Prescription Drug Coverage

Prescription Out-of-Pocket Maximum

Although you automatically receive prescription coverage as part of the medical plan, the out-of-pocket maximum for prescription coverage is separate from the medical out-of-pocket maximum. This limit serves as a financial safety net for you and your family—protecting you from unexpected and expensive prescription drug costs. Your prescription copays and coinsurance count toward meeting this limit. They do not, however, count toward meeting your MEDICAL deductible or out-of-pocket maximum and visa versa.

Prescription Out-of-Pocket Maximum

The Generic Advantage

Generic medications contain the same active  ingredients and have the same quality, strength and purity as the brand name medications they copy. Save money by choosing generics whenever possible.

Manage Your Prescriptions Online

  • Order status
  • Number of refills remaining
  • Rx number
  • Prescription expiration date
  • Prescription order history

myCigna.com

(click “Home Delivery Pharmacy” tab)

Retail Network Pharmacy: 30-day fills

  • Use when you need a prescription filled right away.
  • Show your medical ID card and pay your portion of the cost.
  • Pharmacist will file the claim for you.
  • Includes Walgreens, Rite Aid, CVS, Walmart, Costco, Sam’s Club and most other national pharmacies.

Find a network pharmacy near you

Cigna 90 Now Program: 90-day fills

  • More choice and greater savings opportunities for medicines you take on an ongoing basis for a chronic condition, such as diabetes, asthma or high blood pressure.
  • Lower cost than buying three 30-day prescriptions.
  • Access Cigna’s network of 29,000 “long-term fill” pharmacies, including CVS, Target, Walmart, Kroger and more.

Find participating 90-day retail pharmacies near you:

Cigna.com/Rx90network

Cigna Home Delivery: (Mail Order)

  • An alternative to refilling your prescriptions at a retail pharmacy location.
  • Offers added convenience with prescriptions delivered right to your home. 

To Access: 
Mail: Complete the order form (available at www.myCigna.com) and mail along with your original prescription(s) and your payment to: Cigna Tel Drug, PO Box 1019, Horsham, PA 19044.
Phone: +1 800-Tel-Drug (835-3784).

myCigna.com

Specialty Drugs

Injectable drugs (excluding insulin) used to treat conditions like rheumatoid arthritis, cancer, multiple sclerosis or anemia are covered under the Prescription Drug Program. Your first 30-day supply can be purchased at a retail pharmacy. Subsequent refills must be ordered through the specialty pharmacy mail order service and will be dispensed in 30-day intervals only (90-day supply is not available). In addition, you can take advantage of the specialty pharmacy patient advocate service for guidance and support, as well as self-care information about your condition. 

Step Therapy and Prior Authorization

Often, there are several medication choices available to treat a given medical condition. Though the safety and clinical effectiveness of these choices can be equivalent, the cost can vary widely. This is most apparent with generic medications that are FDA approved to be just as effective as brand-name counterparts. Through Step Therapy, your pharmacist works with your doctor to find the most cost-effective and safest “step one” drug first for treatment of your (or dependent member age 18 or above) condition and then progresses to more costly “step two" brand-name drugs, only if medically necessary.

How Step Therapy Works

There is a sequence of two “steps” in the choice of medication used for the following:

  • High Blood Pressure
  • High Cholesterol (such as Lipitor)
  • Stomach Acid conditions
  • ACE (Angiotensin Converting Enzyme [ACE]) Inhibitors / ARB (Angiotensin II Receptor Blockers) drugs used for controlling high blood pressure, treating heart failure and preventing kidney failure in people with diabetes or high blood pressure
  • Proton pump inhibitors (such as Nexium or Prevacid)

If you try to fill a “step two” brand-name drug, the pharmacy’s system automatically checks to see if you’ve used this before. If you have, the system pays the claim; however, if it is a new prescription, the pharmacist will be directed to call your doctor and suggest trying a more cost-effective “step one” drug, such as a generic equivalent or brand formulary drug. In the meantime, you can still get a temporary supply of the “step two” drug while you await your doctor’s approval.

Prior Authorization

Our Prior Authorization system works with the Specialty Prescriptions and Step Therapy to ensure your drug therapy is appropriate. Prior Authorization is needed for use of non-preferred brand products without prior use of generic and preferred brand products. Also, if you take medications for acne, weight management, hypertension or emphysema, your pharmacist will automatically call your doctor for a diagnosis before filling your prescription.

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