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Cigna made a formulary change to Samsca that may impact customers at your pharmacy. Effective December 15, 2016, Samsca is covered as a specialty medication on Cigna's Prescription Drug List for non-Medicare/Medicaid members. Also, Samsca is considered a "Limited Distribution Drug," meaning the manufacturer has chosen to limit its supply to only a few pharmacies in the United States.
We sent letters to the customers and prescribers explaining the impact, based on customers’ current utilization. However, if a customer with Cigna pharmacy benefits does come in and attempts to refill a prescription for Samsca, when appropriate, we ask that you assist him or her in the following ways:
- Let the customer know Samsca is now considered a specialty medication on Cigna's Prescription Drug List and that it is only available at certain pharmacies in the United States
If you have questions, please see below:
|Point of Service and Processing||800.244.6224||
Customer ID | Customer DOB | Prescription Information
|Pharmacy Contract||Provider.Relations@optum.com||Contract inquiries|
|Reimbursement||Optum.com/pharmacycareservices Select "Pharmacists"||Reimbursement|
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 [PDF] for Cigna Non-Preferred pharmacies to request a higher amount of pharmacy coverage for a patient.