For Cigna Medicare Select Plus Rx

 

Cigna Medicare Select Plus Rx 2014 drug list tier descriptions

Tier 1

Preferred Generic Drugs. This grouping 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 - Notes/Requirements/Limits

B vs D

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 located in a long term care (LTC) setting.

HI

This prescription drug may be covered under our medical benefit.
For more information, call Customer Service at 1-800-627-7534 (TTY: 711).

PA

Prior Authorization is required.

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.

QL

Quantity Limits apply.

RA

Restricted Access. This prescription may be available only at certain pharmacies. For more information consult your Pharmacy Directory or Customer Service at    1-800-627-7534 (TTY: 711).

ST

Step Therapy is required.