Medicare Part D Plans: Getting Prescriptions

What is a formulary?

A formulary (or drug list) lists all drugs that we cover. We will generally cover the drugs on our drug list as long as the drug is medically necessary, the prescription is filled at a network pharmacy and other coverage rules are followed.

Each plan must follow the rules set forth by Medicare in covering Part D drugs. In addition, Medicare must approve our drug list each year and as changes are made.

The drugs on the drug list are selected by our Plan with the help of a team of health care professionals. We select the prescription therapies believed to be a necessary part of a quality treatment program. Both brand-name drugs and generic drugs are included on the list of covered drugs.

Not all drugs are included on the drug list. In some cases, the law prohibits Medicare coverage of certain types of drugs. In other cases, we have decided not to include a particular drug on our drug list because we may have an alternative drug that can be taken. This is one example.

Will my drugs be covered?

Whether your drug is covered will depend on whether it is on the plan's list of covered drugs. Medicare prescription drug plans must include at least two drugs in every drug category. In addition, each Part D plan must:

  • Make sure you have convenient access to retail pharmacies.
  • Have a process to request exceptions to the drug list regarding our coverage rules.
  • Provide useful information to you, such as how drug lists and medication management programs work, information on saving money with generic drugs, and grievance and appeal processes.

Please note: You can also access our network of preferred pharmacies.

What if my drug is not in the drug list?

For information on how to obtain an exception to the Cigna Medicare Rx Prescription drug plan list of covered drugs, contact Cigna Medicare Rx (PDP) Customer Service, 8 am to 8 pm local time, 7 days a week.

Can the drug list change?

We may make certain changes to our list of covered drugs during the year. Changes in the drug list may affect which drugs are covered and how much you will pay when filling your prescription. If we remove drugs from our drug list, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost cost-sharing tier, we will post a notice on this site at least 60 days before the change becomes effective. In addition, you will be notified on your Explanation of Benefits (EOB) mailing, if you are taking the impacted drug.

 

If the FDA deems a drug on our list of covered drugs unsafe, or if a drug is removed from the market by the manufacturer, we will take appropriate actions to help ensure the safety of our customers. These actions may include removing the drug from the drug list. If we do remove the drug, we will provide notification to customers who are taking the drug.

Are generic drugs covered?

All Cigna Medicare Rx prescription drug plans cover both brand-name drugs and generic drugs. Generic drugs have the same active-ingredients as brand name drugs. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.

Are there restrictions on my drug coverage?

There are some covered drugs on the drug list that have additional requirements or limits on coverage. These include:

Prior Authorization - you or your doctor may be required to get a prior authorization for some drugs. This means that you will need to get approval from you plan prior to filling your prescription. If you do not obtain approval, the drug may not be covered.

 

Quantity Limits - For some drugs, the quantity that is covered may be limited by the plan.

 

Step Therapy - you may be required to first try certain drugs to treat your medical condition before we will cover another drug for that condition.

What about drugs that Medicare Part B already covers?

Medicare requires that certain medications and durable medical equipment (like diabetic test strips, nebulizers and wheelchairs) be covered under Part B. Medicare Part D plans usually do not cover drugs that are covered under Medicare Part B.

  

Medicare Part B will typically cover drugs that are administered at a hospital or doctor's office.

Where can I get my prescriptions filled?

In order to receive plan benefits, you must use a network pharmacy, and quantity limitations, and restrictions may apply. Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

  • If you are unable to obtain a covered drug in a timely manner within our service area because there is no network pharmacy within a reasonable driving distance that provides 24-hour service.
  • If you are trying to fill a covered prescription drug that is not regularly stocked at an accessible network retail or mail-order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals).
  • If a covered Part D drug is dispensed by an out-of-network, institution-based pharmacy to a patient who is in the emergency department, provider-based clinic, outpatient surgery or other outpatient settings.

The Cigna Medicare Rx network of over 64,000 network pharmacies may change at any time. Visit the Pharmacy Directory or call our Customer Service team at 1-855-391-2556 from 8 am to 8 pm local time, 7 days a week. (TTY/TDD users call 711).

How will the pharmacist know what to charge me?

You will present your plan's prescription drug card at the pharmacy or send the prescription drug card number if you're using a mail-order pharmacy. The card will electronically access your information - whether or not you still have part of your deductible to pay, what coverage you're entitled to, whether you have extra coverage that reduces your cost and what your copay or coinsurance should be.

What if I take multiple drugs for a chronic illness?


If you have a chronic illness, you may have the option of receiving your routine maintenance prescription medications through Cigna Home Delivery Pharmacy.

Does Cigna offer Home Delivery (Mail-Order)?

Yes, Cigna offers Home Delivery of your Part D prescription drugs. You may save money by using Cigna Home Delivery Pharmacy which provides:

  • Free & quick delivery of all your prescriptions
  • Refill reminders to help ensure you don't miss a dose
  • FDA-approved medications
  • Confidential, tamper-resistant packaging
  • Pharmacists available day or night to answer your questions

If you receive state help in paying for your prescription drugs: contact your State Pharmacy Assistance Program (SPAP) as they may have specific requirements that limit your Home Delivery benefit.

Does Cigna offer preferred pharmacies?

Cigna has contracted with five pharmacy chains in order to provide customers even more savings. Customers can fill their drugs at any of Cigna's network pharmacies; however they will save even more if they fill their prescriptions at one of our preferred pharmacies.

What is an MTMP program?

MTMP is a program that may assist qualified Cigna Medicare Rx customers who:

  • Take multiple prescription drugs
  • Have chronic conditions
  • Expect to spend a significant amount of money on prescription drugs each year

MTMP can help identify potential errors and gaps in your care by:

  • Helping reduce the risk of medication errors - especially if you have chronic conditions, take several medications or see multiple doctors
  • Providing current information on proven medical practices to help you and your doctor determine the most effective treatment
  • Helping you understand your condition and medications, so you can take an active role in managing your health.

Learn more about our Medication Therapy Management Program

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