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March 2011

PHARMACY UPDATE

CIGNA Pharmacy Step Therapy Program to Expand

Most pharmacy benefit plans include a step therapy program to encourage the use of lower cost, clinically appropriate generic or preferred-brand medications. For many conditions, several medication options are available. Step therapy helps an individual and his or her physician choose the most cost-effective, therapeutically appropriate medication as the first option, before other, more costly, prescription medication options are considered. If a first- or second-step medication is not effective, individuals try another medication, moving first to preferred- brand medications and then to non-preferred brands.

 

As a prescribing physician, you may currently receive information about CIGNA's Step Therapy program, which includes medication to treat hypertension, hypercholesterolemia and gastric acid conditions.

Beginning in May 2011, the CIGNA Step Therapy program will expand to include medications to treat 11 additional common medical conditions:

ADD/ADHD agents

NSAIDs (non-narcotic pain relievers)

Atypical antipsychotic agents

Oral narcotic analgesics for acute pain

Beta adrenergic nebulizer solutions for asthma

SSRI/SNRIs (depression medications)

Bone resorption inhibitors

Topical immunomodulators

Hypnotics

Urinary tract antispasmodics

Inhaled nasal steroids  (Allergy)

 

 

To help minimize disruption, the first fill of a medication subject to step therapy requirements will be covered without interruption, but will trigger a written notification to you and your patient, informing them of the action that needs to be taken before the next fill.

 

We recognize that there may be cases when initial use of a second- or third-level step therapy drug is medically necessary. In these instances, you can request prior authorization for coverage at any time for your patient. Requests for prior authorization can be made using the CIGNA HealthCare Prior AuthorizationForm, which is available on www.cigna.com, or by calling the CIGNA Pharmacy Services Center at1.800.244.6224. All prior authorization requests should be faxed at least seven days before to the patient’s next refill.

 

Step Therapy drugs requiring prior authorization are listed on the CIGNA Prescription Drug list on the secure CIGNA for Health Care Professionals website (www.cignaforhcp.com) with an “ST” indicator. A separate prescription drug list for patients with GWH-CIGNA ID cards is available on the Secured Provider Portal (www.gwhcignaforhcp.com). The list on the Secured Provider Portal also indicates the drugs that are included in the Step Therapy program.

 

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