Transitioning into your new CIGNA Medicare plan CIGNA Medicare Services® wants to make sure that all individuals enrolled in our plans transition smoothly into the new plan year. With the plan changes that occur each year, some changes may affect what drugs are covered and how they are covered. For the new plan year, some medications that are covered and their tier placement may have changed. The CIGNA Medicare Services drug lists (formularies) will continue to cover the most commonly used drugs for Medicare-eligible individuals. However, in some cases, medications that have either a direct generic equivalent or a therapeutic alternative on our drug list (formulary) may not be covered. Some medications may also be subject to step therapy, prior authorization, quantity limitations, or further clinical review. New and existing customers who are negatively affected by any drug list (formulary) changes will be extended coverage on their medication through the CIGNA Medicare Services transitional benefit policy, which is described below. New Customer One-Time Transition Supply New customers to our plan may currently be taking drugs that are on our drug list (formulary) but their ability to get them may be limited. In this case, they need to talk with their doctor about appropriate alternative medications available on our drug list (formulary) that do not have such limitations. If there are no appropriate alternative medications on our drug list (formulary) without limitations, they or their doctor may request a drug list (formulary) exception. If the exception is approved, they will be able to continue taking that drug for a specified period of time. While they are talking with their doctor to determine what to do next, they may be eligible to receive an initial 31-day transition supply of the drug anytime during the first 90 days they are enrolled in our plan. For each of their drugs that have a limitation, we will cover a temporary 31-day supply (unless they have a prescription written for fewer days) when they go to a network pharmacy. After their first 31-day transitional supply, we may not continue to pay for these drugs under the transition policy. If they are a resident of a long-term care facility, we will cover a temporary 34-day transition supply (unless they have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days they are enrolled in our plan. If the drug they need is subject to a coverage review, and they are past the first 90 days in our plan, we will cover a 31-day emergency supply of that drug (unless they have a prescription for fewer days) while they pursue a drug list (formulary) exception. Continuing Customers From Previous Year Plan Continuing customers in our plan should have received their Annual Notice of Change (ANOC) by September 30th. Due to plan year changes, a medication on the drug list (formulary) which they are currently taking may have either a different copay or coinsurance, have limited coverage, or is subject to prior authorization, quantity limits or step therapy in the upcoming year. In this case, individuals must work with their doctor to either find an appropriate alternative medication on our new drug list (formulary) or request a drug list (formulary) exception prior to January 1st. If the exception request is approved, we will authorize payment prior to January 1st and provide coverage beginning January 1st. If individuals do not receive approval for their drug list (formulary) exception request prior to January 1st, they may be eligible to receive an initial 31-day transition supply while they continue to work with their doctor to find an appropriate alternative medication. If they are a resident of a long-term care facility, we will cover a temporary 34-day transition supply (unless they have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days of the plan year. Level of Care Changes An extended transition process is provided in circumstances involving level of care changes in which an individual is changing from one medication to another. An override for the “refill too soon” code would be provided to allow appropriate coverage. Since there may be some time in which individuals with level of care changes have a temporary gap in coverage while going through the exception process, our transition policy would allow coverage of one fill with up to 31-day supply of medication.
S5617_6308c CMS Approved 07192011
826308c 07/11
"CIGNA Medicare Services" and the "Tree of Life" logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. These products and services are offered by operating subsidiaries Connecticut General Life Insurance Company and CIGNA HealthCare of Arizona, Inc., and not by CIGNA Corporation. Connecticut General Life Insurance Company is a Medicare approved Part D sponsor. CIGNA HealthCare of Arizona, Inc. is a Medicare Advantage organization with a Medicare contract.
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