Cigna may make changes to our drug lists which can affect customers at the pharmacy. We include a list of impacted drugs – by drug class – that will be considered non-covered, non-preferred brand or require approval from Cigna for coverage, as well as the covered alternatives.
We send letters to our customers who are impacted explaining the changes to their current medications. However, if a customer with Cigna pharmacy benefits does attempt to refill a medication that is not covered, when appropriate, they can be assisted 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
- Help the customer fill out this simple form below to bring to their prescriber [PDF]
Drug Coverage Changes by Class
Please note that this list only applies to our non-Medicare Standard Prescription Drug List and does not reflect the entire list of covered and not-covered drugs for this or any other Cigna drug list.
| Drug class | Non-preferred brand** medication** | Generic and/or preferred brand alternatives |
|---|---|---|
| Infections | Daklinza+ | Epclusa+, Harvoni+, Sovaldi+ |
| Drug class | Medication not covered^ | Generic and/or preferred brand alternatives |
|---|---|---|
| Blood Pressure/ Heart Medications | Cardizem | Diltiazem |
| Isordil Titradose | digitek, digox, digoxin | |
| Lanoxin | isosorbide dinitrate | |
| Cholesterol Medications | Antara, Fenoglide | fenofibrate |
| Cough/Cold Medications | Tussicaps | hydrocodone-chlorpheniramne ER, promethazine-codeine |
| Diuretics | Edecrin, ethacrynic acid | bumetanide,furosemide, torsemide |
| Gastrointestinal/ Heartburn | Anusol-HC suppository | anucort-HC, Grx Hicort 25, hemmorex-HC, hydrocortisone, rectacort HC |
| Omeclamox- pak, Prevpac, Pylera | lansoprazole-amoxicilin-clarithromycin (combo pak) | |
| Hormonal Agents | Dexpak | dexamethasone |
| Infections | Onmel | itraconazole, terbinafine |
| Pain Relief and Inflammatory Disease | Conzip | tramadol, tramadol ER |
| Levorphanol tartate | acetaminophen-codeine, hydrocodone acetaminophen, hydromorphone ER, hydromorphone, lorcet, lorcet HD, lorcet plus, oxycodone, oxycodone ER, tramadol, verdrocet, vicodin, vicodin ES, vicodin HP | |
| Naprelan, naproxen CR, naproxen ER, Zipsor | diclofenac, diclofenac ER, etodolac, etodolac ER, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, meloxicam, nabumetone, naproxen, naproxen DS, oxaprozin, piroxicam, sulindac, tolmentin | |
| Zomig ZMT | zolmitriptan ODT | |
| Skin Conditions | Aldara | Imiquimod |
| Anusol-HC cream | hydrocortisone, protco-med HC proctosol-HC, proctozone-HC | |
| Clobex | clobetasol, clodan shampoo | |
| Ertaczo | ketoconazole | |
| Extina | ketoconazole, ketodan | |
| Halog | clobetasol propionate, halobetasol propionate | |
| Locoid lipocream | hydrocortisone butyrate | |
| Loprox | ciclodan, ciclopriox | |
| Oxistat | clotrimazole econazole nitrate, ketoconazole, oxiconazole nitrate | |
| Penlac | Ciclodan, ciclopirox | |
| Prudoxin | doxepin | |
| Salex | salicylic acid | |
| Trianex | Triamcinolone acetonide, triderm | |
| Ultravate | Ala-cort, alclometasone dipropionate, aminonide, apexicon, betamethasone dipropinate, betamethasone valerate, clobetasol emollient, clobetaslon emulsion, clobetasol propionate, clocortonlone pivalate, clodan, cormax, desonide, desoximetasone, diflorasone diacetate, fluocinolene acetonide, fluocinonide, fluocinonide-E, flurandrenolide, fluticasone propionate, halobetasol propionate, hydrocortisone, hydrocortisone butyrate, hydrocortisone valerate, micort-HC, mometasone furoate, prednicarbate, psorcon, scalacort, tacrolimus, triamcinolone acetonide, trianex, triderm | |
| Ultravate X | clobetasol propionate, halobetasol propionate | |
| Verdeso | desonide | |
| Vusion | ketoconazole | |
| Zonalon | doxepin, prudoxin | |
| Sleep Disorders/ Sedatives | Ambien Ambien CR |
Zolpidem zolpidem ER |
| Drug class | Medication requiring prior authorization | Additional information |
|---|---|---|
| Miscellaneous | Syprine | |
| Pain Relief and Inflammatory Disease | acetaminophen-codeine, ascomp with codeine, aspirin-caffeine-dihydrocodeine, belladonna-opium, butalbital-acetaminophen caffeine-codeine, butalbital-caffeine-acetaminophen codeine, butalbital compound-codeine, butorphanol, carisoprodol compound-codeine, carisoprodol-aspirin-codeine, codeine, Demerol, dihydrocodeine-acetaminophen-caffeine, Dilaudid, Duragesic, Embeda, Endocet, Exalgo, fentanyl patch, Fioricet with Codeine, Hycet, hydrocodone-acetaminophen, hydrocodone ibuprofen,hydromorphone, hydromorphone ER, Hysingla ER, Ibudone, Kadian ER, levorphanol tartrate, Lorcet, Lorcet HD, Lorcet Plus, Lortab, meperidine, morphine sulfate, morphine sulfate ER, MS Contin, norco, Nucynta, Nucynta ER, Opana, Opana ER, Oxaydo, oxycodone acetaminophen, oxycodone-aspirin, oxycodone-ibuprofen, oxycodone, oxycodone ER, oxymorphone ER, oxymorphone, Oxycontin, pentazocine-naloxone, Percocet, Primlev, Reprexain, Roxicodone, Synalgos-DC, trezix, Tylenol-codeine, Verdrocet, Vicodin, Vicodin ES, Vicodin HP, Xartemis XR,Xodol, Xtampza ER, Xylon 10, Zamicet, Zohydro ER | Ask your doctor to call us. Your plan will only cover your medication if your doctor requests and receives approval from Cigna. |
| Pain Relief and Inflammatory Disease | Cuprimine, Depen Titratab | |
| Drug class | Medication with quantity limits | Additional information |
|---|---|---|
| Cough/ Cold Medications | Flowtuss, hycofenix, Hydrocod-cpm-pseudoephedrine, Hydrocodone BT-homatropine, Hydrocodone-chlorpheniramne ER, Hydrocodone-homatropine, hydromet, obredon, Promethazine VC-codeine, Promethazine-codeine, Promethazine-phenyleph-codeine, Rezira, Tussicaps, Tussigon, Tussionex, Tuzistra XR, Vituz, Zutripro | Your plan only covers a certain amount of this medication. If your doctor writes a prescription for an amount more than what’s allowed, it will only be covered in that amount if your doctor requests and receives approval from Cigna. |
| Gastrointestinal/ Heartburn | Opium Tincture | |
| Miscellaneous | Evzio, Naltrexone | |
| Pain Relief and Inflammatory Disease | Abstral, acetaminophen-codeine, actiq, alfentanil, ascomp with codeine, aspirin-caffeine- dihydocodeine, belladonna- opium, butalbital-acetaminophen-caffeine- codeine, butalbital-caffeine-acetaminophen-codeine, butalbital compound-codeine, butalbital-acetaminophen-caffeine, butalbital-aspirin-caffeine, butorphanol, capacet, carisoprodol compound-codeine, carisoprodol-aspirin-codeine, codeine, Demerol, dihydrocodeine-acetaminophen-caffeine, Dilaudid, duramorph, Endocet, esgic, fentanyl patch, fentanyl-bupivacacaine, fentora, fioricet, fioricet with codeine, fiorinal, finorinal with codeine, hycet, hydrocodone-acetaminophen, hydrocodone-ibuprofen, hydromorphone, Ibudone, infumorph, ionsys, lazanda, levorphanol, Lorcet, Lorcet HD, Lorcet Plus, Lortab, meperidine, morphine, nalbuphine, norco, Nucynta, Nucynta ER, Opana, Oxaydo, oxycodone, oxycodone-aspirin, oxycodone-ibuprofen, oxycodone-acetaminophen, oxymorphone, pentazocine-naloxone, Percocet, Primlev, Reprexain, Roxicodone, subsys, sufentanil, Synalgos- DC, talwin, trezix, Tylenol-codeine, ultiva, Verdrocet, Vicodin, Vicodin ES, Vicodin HP, Xodol,10-300, xodol 5-300, xodol 7.5-300, Xylon 10, zamicet, zebutal |
* Drug is not covered unless approved through a medical necessity review. Customers should speak with their provider about switching to a covered alternative drug.
^ In Step Therapy, customers must try the most cost-effective, appropriate drugs available before their plan approves more expensive brand name drugs.
Pharmacy Forms
Submit a Maximum Allowable Cost (MAC) review form [PDF] 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.