FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS
Effective January 1, 2017, Cigna has made formulary changes that may affect customers at your pharmacy. Cigna has limited the number of preferred drugs in certain drug classes within our formularies. Some drug classes now feature one or a select set of preferred brand name drugs, and other brand name equivalent drugs are covered by going through Cigna’s medical necessity review process. We have included a list of drugs – by drug class – that are considered non-covered or non-preferred brand as of January 1, 2017 and their covered alternatives. We sent letters to the customers and prescribers explaining the effect, based on their current medications. However, if a customer with Cigna pharmacy benefits does come in and attempts to refill a medication that is not covered, when appropriate, we ask that you assist them in the following ways:
- Mention the alternative covered drugs available in the chart below
- Urge the customer to meet with the prescriber to discuss these alternatives or please call the prescriber to facilitate the new prescription
Please help the customer fill out this simple form to bring to their prescriber.
| Drug class | Non-preferred brand medication | Generic and/or preferred brand alternatives |
|---|---|---|
| Blood Modifiers/Bleeding Disorders | Neupogen+ | Granix, Zarxio |
| Cancer | Gleevec | imatinib mesylate |
| Cholesterol Medications | Lescol XL | generic statins |
| Pain Relief & Inflammatory Disease | Kadian, Nucynta ER, Xartemis XR | Hysingla ER, OxyContin, Xtampza ER |
| Drug class | Medication not covered^ | Generic and/or preferred brand alternatives |
|---|---|---|
| Allergy/Nasal Sprays | Beconase AQ, Dymista, Nasonex, Omnaris, QNASL, Veramyst, Zetonna | budesonide, flunisolide, fluticasone propionate, mometasone furoate, triamcinolone acetonide |
| QNASL Children | fluticasone propionate, budesonide, triamcinolone acetonide | |
| Anxiety/Depression/Bipolar Disorder | Aplenzin | bupropion XL |
| Ativan | lorazepam | |
| Pexeva | paroxetine | |
| Asthma/COPD/Respiratory | Aerospan, Alvesco, Arnuity Ellipta, Asmanex, Asmanex HFA, Flovent Diskus, Flovent HFA | QVAR, Pulmicort Flexhaler |
| Dulera | Advair HFA, Advair Diskus, Breo Ellipta, Symbicort | |
| Incruse Ellipta, Tudorza Pressair | Spiriva, Spiriva Respimat | |
| Proventil HFA, Xopenex HFA | ProAir Respiclick, ProAir HFA, Ventolin HFA | |
| Blood Pressure/Heart Medications | Cardizem CD | cartia XT, diltiazem 24hr CD, diltiazem 24hr ER |
| Isordil | isosorbide | |
| Diabetes | Fortamet, metformin ER (when filled as generic to Glumetza) | metformin ER (when filled as generic to Glucophage XR or generic to Fortamet) |
| Jardiance, Synjardy | Invokamet, Invokana, Farxiga, Xigduo XR | |
| Tanzeum, Victoza | Trulicity, Bydureon, Byetta | |
| Gastrointestinal/Heartburn | Asacol HD, Colazal, Delzicol, Dipentum, Giazo | Apriso, balsalazide, Lialda, mesalamine, Pentasa, sulfasalazine |
| Librax | chlordiazepoxide-clidinium | |
| Metozolv ODT | metoclopramide, metoclopramide ODT | |
| Nexium | esomeprazole magnesium | |
| Pepcid | famotidine | |
| Zegerid | omeprazole-sodium bicarbonate, omeprazole, omeprazole+syrspend sf alka | |
| Zuplenz | ondansetron, ondansetron ODT | |
| Hormonal Agents | Rayos | prednisone, prednisone intensol |
| Saizen | Humatrope |
| Drug class | Medication not covered^ | Generic and/or preferred brand alternatives |
|---|---|---|
| Infections | Bethkis, Tobi | Kitabis Pak, tobramycin |
| Sitavig | acyclovir | |
| Pain Relief and Inflammatory Disease | Amrix | baclofen, carisoprodol, cyclobenzaprine, methocarbamol, tizanidine |
| Belbuca | Butrans | |
| diclofenac 1.5% solution, klofensaid II, Pennsaid | diclofenac 1% gel, generic oral NSAIDs (diclofenac, ibuprofen, meloxicam, naproxen) | |
| Lido-K | lidocaine, lidopin | |
| Sprix | ketorolac tromethamine | |
| Treximet | generic triptans (naratriptan, sumatriptan, zolmitriptan) plus a generic NSAID (ibuprofen, meloxicam, naproxen) | |
| Zembrace Symtouch | sumatriptan | |
| Schizophrenia/Anti-Psychotics | Abilify, Abilify ODT | |
| Fazaclo, Versacloz | ||
| Seizure Disorders | Mysoline | |
| Skin Conditions | Absorica | claravis, myorisan, zenatane |
| Benzaclin, Duac, Neuac kit | clindamycin-benzoyl peroxide, neuac gel | |
| Carac | fluorouracil | |
| Clindagel | clindamycin phosphate | |
| Jublia, Kerydin | ciclodan, ciclopirox, itraconazole, terbinafine | |
| Noritate | metronidazole, rosadan | |
| Novacort | hydrocortisone | |
| Vanos | fluocinonide | |
| Xerese | acyclovir, hydrocortisone | |
| Zovirax | acyclovir | |
| Zyclara | imiquimod | |
| Sleep Disorders/Sedatives | Edluar, Intermezzo | zolpidem tartrate, zolpidem tartrate ER |
| Substance Abuse | Evzio | naloxone vial & PFS, Narcan |
| Urinary Tract Conditions | Myrbetriq, Toviaz, VESIcare | darifenacin ER, oxybutynin chloride ER, tolterodine tartrate ER, trospium chloride ER |
| Drug class | Medication with Quantity Limits |
|---|---|
| Pain Relief and Inflammatory Disease | Lidocaine 5% ointment |
Pharmacy Forms
Submit a Maximum Allowable Cost (MAC) review form for Cigna Preferred pharmacies to request a higher amount of pharmacy coverage for a patient.
Submit an Optum Maximum Allowable Cost (MAC) review form for Cigna Non-Preferred pharmacies to request a higher amount of pharmacy coverage for a patient.