December 2016 Non-Medicare Formulary Change

When Cigna makes formulary changes that may affect customers at your pharmacy, we provide you with a list of the drugs that are affected.

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:

Question:Contact:Issue Type:
Point of Service and Processing 800.244.6224
  • Refill too Soon
  • Drug Coverage Issues
  • Copay Issues
  • You will need the following information for the phone prompts:
  •  

Customer ID | Customer DOB | Prescription Information

Pharmacy Contract Provider.Relations@optum.com Contract inquiries
Reimbursement Optum.com/pharmacycareservices Select "Pharmacists" Reimbursement

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 [PDF] for Cigna Non-Preferred pharmacies to request a higher amount of pharmacy coverage for a patient.

View all Pharmacy forms at CignaforHCP