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Cigna Medicare Rx Secure (PDP), Cigna Medicare Rx Secure-Xtra (PDP) and Cigna Medicare Rx Secure-Max (PDP) 2014 Drug List Tier Descriptions

Tier 1

Preferred Generic Drugs. This grouping of prescription drugs represents the lowest cost-sharing.

Tier 2

Non-Preferred Generic Drugs.

Tier 3

Preferred Brand Drugs.

Tier 4

Non-Preferred Brand Drugs.

Tier 5

Specialty Tier Drugs. This grouping of prescription drugs represents the highest cost-sharing.

 

Symbol Key - Requirements/Limits

B vs D

Coverage determination for Part B or Part D required. This drug may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination. Note: Inhalant solutions used in a nebulizer are only covered under Part D when the customer is in a Long Term Care (LTC) Setting.

GC

Gap Coverage - We provide additional coverage of this prescription drug in the coverage gap. Please refer to our Evidence of Coverage for more information about this coverage.

NC

Not Covered - If "NC" is shown in the Plan Tier column for a given drug, it is not covered under that plan. Please consult with your physician for alternative medications.

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

PA

Prior Authorization - Your doctor must obtain a prior approval for this drug.

QL

Quantity Limit - You may only obtain coverage for a limited amount of this drug.

RA

Restricted Access - This drug may be available only at certain pharmacies.

ST

Step Therapy - You must first use another drug before these drugs can be approved for use.