VALUE PRESCRIPTION DRUG LIST More generics and lower-cost brands to help you stay healthy and save money Your prescription drug list Your plan will be using a different prescription drug list - it’s called the Value Prescription Drug List. You’ll notice that your new drug list:
› Includes more generic and lower-cost brand medications. Generic medications offer the same strength and active ingredients as the brand name but often cost much less – in some cases, they could cost 80–85% less.1
› May list brand medications in a different tier › Excludes medications in two drug classes that are available over-the-counter without a prescription. These include medications commonly used to treat:
– Heartburn and stomach acid conditions (ex. Nexium, Prilosec, Zantac and any generics) and
– Allergies (ex. Allegra, Clarinex, Xyzal and any generics) Medications where you may pay more
Starting January 1, 2017, the medications listed below will be non-preferred on the Value Prescription Drug List. If you’re currently taking one of these medications, you may pay more to fill your prescription. DRUG CLASS
NON-PREFERRED BRAND MEDICATION
GENERIC &/OR PREFERRED BRAND ALTERNATIVES
ALLERGY/NASAL SPRAYS
Astepro
azelastine
Bactroban Nasal
mupirocin
ALZHEIMER'S DISEASE
Namenda
memantine
ASTHMA/COPD/RESPIRATORY
Combivent Respimat
Anoro Ellipta, Spiriva, Spiriva Respimat, Stiolto Respimat
ATTENTION DEFICIT HYPERACTIVITY DISORDER
Strattera
clonidine ER, dextroamphetamine sulfate ER, guanfacine ER
BLOOD PRESSURE/HEART MEDICATIONS
Multaq
amiodarone
Nitro-dur
minitran, nitroglycerin patch
Nitrostat
nitroglycerin
Tikosyn
amiodarone, flecainide acetate, propafenone, propafenone ER, sotalol, sotalol AF
BLOOD THINNERS/ANTI-CLOTTING
Effient
clopidogrel
CANCER
Gleevec
imatinib mesylate
CHOLESTEROL MEDICATIONS
Welchol
cholestyramine, cholestyramine light, colestipol, prevalite
Para obtener ayuda en español llame al número en su tarjeta de Cigna. 863485 ValueDRT 08/16
DRUG CLASS
NON-PREFERRED BRAND MEDICATION
GENERIC &/OR PREFERRED BRAND ALTERNATIVES
DIURETICS
Edecrin
bumetanide, furosemide, torsemide
EAR MEDICATIONS
Cipro HC, Ciprodex
ciprofloxacin
EYE CONDITIONS
Alphagan P
brimonidine tartrate
Azasite, Moxeza, Vigamox
ciprofloxacin, gatifloxacin, levofloxacin, ofloxacin
Azopt
dorzolamide
Betoptic S
betaxolol
Lotemax drops, Lotemax gel
dexamethasone sodium phosphate, fluorometholone, prednisolone acetate, prednisolone sodium phosphate
Pataday, Patanol
azelastine, epinastine
Tobradex ointment
tobramycin-dexamethasone
Canasa
mesalamine
Carafate oral suspension
sucralfate
Emend
granisetron, granisol, ondansetron, ondansetron ODT
Androderm
Androgel, testosterone
Armour Thyroid, Synthroid, Unithroid
levothyroxine
Cytomel
liothyronine
Divigel, Estring
estradiol, estropipate, Premarin
Enjuvia
estradiol, Premarin
Oracea
avidoxy, demeclocycline, doxycycline, minocycline, mondoxyne, morgidox, tetracycline
Valcyte
valganciclovir
MISCELLANEOUS
Zavesca
Cerdelga
NUTRITIONAL/DIETARY
CitraNatal, OB Complete Gold, Prenate, Vitafol, vitaMedMD, vitaPearl
generic prenatal vitamins
Klor-Con M15
potassium chloride
K-Tab ER
klor-Con 10, klor-Con 8, potassium chloride
Colchicine, Colcrys
probenecid-colchicine
Nucynta
codeine/APAP, hydrocodone/APAP, hydromorphone, oxycodone, tramadol
Proctofoam-HC
hydrocortisone-pramoxine, pramcort
Savella
duloxetine, venlafaxine ER
Uloric
allopurinol
Vimpat
gabapentin, lamotrigine, levetiracetam, topiramate, zonisamide
GASTROINTESTINAL/HEARTBURN
HORMONAL AGENTS
INFECTIONS
PAIN RELIEF AND INFLAMMATORY DISEASE
SEIZURE DISORDERS
DRUG CLASS
NON-PREFERRED BRAND MEDICATION
GENERIC &/OR PREFERRED BRAND ALTERNATIVES
SKIN CONDITIONS
Azelex
adapalene, clindacin, clindamycin phosphate, clindamycinbenzoyl peroxide, erythromycin, tretinoin
Cordran
betamethasone, fluocinolone acetonide, fluticasone propionate, mometasone furoate, triamcinolone acetonide
Differin
adapalene
Finacea, Metrogel
metronidazole, rosadan, sodium sulfacetamide-sulfur
Naftin
ciclopirox, naftifine
Tazorac
topical tretinoin and topical generic steroids (alclometasone dipropionate, betamethasone, clobetasol, fluocinonide, triamcinolone)
SUBSTANCE ABUSE
Suboxone
buprenorphine-naloxone
TRANSPLANT MEDICATIONS
Neoral capsule
cyclosporine modified, gengraf
URINARY TRACT CONDITIONS
Jalyn
alfuzosin ER, dutasteride, dutasteride-tamsulosin, finasteride, tamsulosin
Medications not covered^ Starting January 1, 2017, the brand name medications listed below will not be covered on the Value Prescription Drug List.^ If you continue to fill a prescription for any of these medications, on or after this date, it won’t be covered and, you’ll have to pay the full cost of the medication. DRUG CLASS
MEDICATION NOT COVERED^
ALLERGY/NASAL SPRAYS
Beconase AQ, Dymista, Nasonex, Omnaris, QNASL, Veramyst, Zetonna QNASL Children Aplenzin Ativan Pexeva Pristiq ER
ANXIETY/DEPRESSION/BIPOLAR DISORDER
ASTHMA/COPD/RESPIRATORY
ATTENTION DEFICIT HYPERACTIVITY DISORDER
Aerospan, Alvesco, Arnuity Ellipta, Asmanex, Asmanex HFA Flovent Diskus, Flovent HFA, Pulmicort Flexhaler Dulera, Symbicort Incruse Ellipta, Tudorza Pressair Proventil HFA, Ventolin HFA, Xopenex HFA Serevent Diskus Vyvanse
GENERIC &/OR PREFERRED BRAND ALTERNATIVES
budesonide, flunisolide, fluticasone propionate, mometasone furoate, triamcinolone acetonide budesonide, fluticasone propionate, triamcinolone acetonide bupropion XL lorazepam paroxetine bupropion SR, bupropion XL, duloxetine, generic SSRIs (fluoxetine, paroxetine, sertraline), venlafaxine ER QVAR
Advair Diskus, Advair HFA, Breo Ellipta Spiriva, Spiriva Respimat ProAir Respiclick, ProAir HFA Striverdi Respimat Adderall XR, dexmethylphenidate ER, dextroamphetamineamphet ER, methylphenidate ER, methylphenidate LA
DRUG CLASS
MEDICATION NOT COVERED^
BLOOD PRESSURE/HEART MEDICATIONS
Bystolic Cardizem Cardizem CD Cozaar Diovan Diovan HCT Edarbi Edarbyclor Exforge Exforge HCT Hyzaar, Lotensin HCT, Micardis HCT, Tekturna HCT
GENERIC &/OR PREFERRED BRAND ALTERNATIVES
Antara Crestor Livalo Vytorin, Lescol XL Tussicaps
atenolol, betaxolol, bisoprolol, metoprolol diltiazem cartia XT, diltiazem 24hr CD, diltiazem 24hr ER losartan valsartan valsartan-HCTZ generic ARBs (irbesartan, losartan, valsartan) generic ARBs +HCTZ (irbesartan, losartan, valsartan) (+HCTZ) amlodipine-valsartan amlodipine-valsartan-HCTZ generic ACE or generic ARB + HCTZ (enalapril, lisinopril, irbesartan, valsartan + HCTZ) amlodipine besylate-benazepril telmisartan generic ACE or generic ARB (enalapril, lisinopril, irbesartan, valsartan) fenofibrate rosuvastatin calcium atorvastatin, rosuvastatin, simvastatin atorvastatin, rosuvastatin, simvastatin, Zetia hydrocodone-chlorpheniramne ER, promethazine-codeine
EYE CONDITIONS
Bydureon, Byetta, Tanzeum, Victoza Farxiga, Jardiance, Synjardy, Xigduo XR Fortamet, metformin ER (generic to Glumetza) Levemir, Levemir FlexTouch Novolin, Novolog Lumigan
Trulicity Invokamet, Invokana metformin ER Lantus, Lantus SoloStar, Toujeo SoloStar Humalog, Humulin bimatoprost, latanoprost, Travatan Z, travoprost
GASTROINTESTINAL/HEARTBURN
Anusol-HC
anucort-hc, grx hicort 25, hemmorex-hc, hydrocortisone acetate, rectacort-hc Apriso, balsalazide, Lialda, Pentasa, sulfasalazine hemmorex-hc, hemril, hydrocortisone acetate prednisone Humatrope budesonide EC Kitabis Pak, tobramycin itraconazole, terbinafine acyclovir
Lotrel Micardis Tekturna CHOLESTEROL MEDICATIONS
COUGH/COLD MEDICATIONS DIABETES
HORMONAL AGENTS
INFECTIONS
Asacol HD, Colazal, Delzicol, Dipentum, Giazo Proctocort Rayos Saizen Uceris Bethkis, Tobi Onmel Sitavig
DRUG CLASS
MEDICATION NOT COVERED^
PAIN RELIEF AND INFLAMMATORY DISEASE
Amrix Cambia, Tivorbex, Vivlodex, Zipsor, Zorvolex diclofenac 1.5% solution, klofensaid II, Pennsaid Gralise, Horizant Kineret, Simponi, Simponi Aria Lorzone Sumavel Dosepro Treximet
SCHIZOPHRENIA/ANTI-PSYCHOTICS SKIN CONDITIONS
SLEEP DISORDERS/SEDATIVES
URINARY TRACT CONDITIONS
Zomig ZMT Abilify, Abilify ODT Absorica Aldara, Zyclara Benzaclin, Duac, Neuac kit Carac Clindagel Clobex Extina Jublia, Kerydin Kenalog Locoid Luzu Noritate Plexion Trianex Verdeso Ziana Zovirax Ambien Ambien CR Edluar, Intermezzo Myrbetriq, Toviaz, VESIcare
GENERIC &/OR PREFERRED BRAND ALTERNATIVES
baclofen, carisoprodol, cyclobenzaprine, methocarbamol, tizanidine generic NSAIDs (diclofenac, ibuprofen, indomethacin, meloxicam, naproxen) diclofenac 1% gel, generic oral NSAIDs (diclofenac, ibuprofen, meloxicam, naproxen) gabapentin Enbrel, Humira chlorzoxazone sumatriptan succinate generic triptans (naratriptan, sumatriptan, zolmitriptan) plus a generic NSAID (ibuprofen, meloxicam, naproxen) zolmitriptan ODT aripiprazole claravis, myorisan, zenatane imiquimod clindamycin-benzoyl peroxide, neuac gel fluorouracil clindamycin phosphate clobetasol propionate, clodan ketoconazole, ketodan ciclodan, ciclopirox, itraconazole, terbinafine triamcinolone acetonide hydrocortisone butyrate ketoconazole metronidazole, rosadan, sodium sulfacetamide-sulfur sodium sulfacetamide-sulfur, ss 10-2, zencia triamcinolone acetonide, triderm desonide clindamycin phosphate, tretinoin acyclovir zolpidem tartrate zolpidem tartrate ER zolpidem tartrate, zolpidem tartrate ER darifenacin ER, oxybutynin chloride ER, tolterodine tartrate ER, trospium chloride ER
^These medications aren’t covered on your drug list. Your prescription drug plan requires approval from Cigna for these medications to be covered. If your doctor feels that an alternative medication isn’t right for you, he or she can ask Cigna to consider approving coverage of your medication.
What these changes mean for you
› You should talk to your doctor to find out which of the covered generic, preferred brand or over-the-counter alternatives will work for you.
› You can also use the Drug Cost tool on myCigna.com to see how these changes may affect the cost of your medication.
If you have questions, please call customer service using the number on the back of your Cigna ID card. We’re here to help.
1. U.S. Food and Drug Administration (FDA) website, “Facts About Generic Drugs.” Retrieved 06/19/15. 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 from a 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 the prescription. If you use a pharmacy that does not participate in your plan’s network, the prescription may not be covered, or reimbursement may be limited by your plan’s copayment, coinsurance or deductible requirements. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and complete details of coverage, see your plan documents. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company (CGLIC), Cigna Behavioral Health, Inc., Cigna Health Management, Inc., Tel-drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of Cigna Health Corporation, including Cigna HealthCare of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc., Cigna HealthCare of Florida, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Indiana, Inc., Cigna HealthCare of St. Louis, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of New Jersey, Inc., Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of Tennessee, Inc. (CHC-TN), and Cigna HealthCare of Texas, Inc. Policy forms: OK - HP-APP-1 et al (CHLIC), GM6000 C1 et al (CGLIC); TN - HP-POL43/HC-CER1V1 et al (CHLIC), GSA-COVER, et al (CHC-TN). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 863485 ValueDRT 08/16 © 2016 Cigna. Some content provided under license.
