Medicare Part D

Help customers with Cigna Medicare Part D forms and processes

Proof of Coverage

Members enrolled in Cigna Medicare Rx (PDP) may begin using network pharmacies to fill their prescriptions. On occasion, a Cigna Medicare Rx (PDP) member will need access to the pharmacy, but may not yet have received their ID Card.

When a member has not yet received their Cigna Medicare Rx (PDP) ID Card, they may use this CMS approved letter for proof of insurance coverage until they receive their ID card.

If a Cigna Medicare Rx (PDP) member requests a prescription fill and does not have an ID card or letter, please contact Cigna Medicare Rx (PDP) Customer Service 1 (800) 222-6700 to confirm insurance coverage.

Download the Sample Enrollment Acknowledgement Letter [PDF]

Notice of Coverage Rights

CMS requires that all pharmacies provide Medicare members with the Notice of Coverage Rights upon the following NCPDP notifications:

NCPDP Approval Code 018

NCPDP Reject Code 569

Download the Medicare Part D Standardized Pharmacy Notice and Instructions [PDF]

Copay Reduction Requests

If members require a reduced copay of a non-preferred brand name medication, we offer a Copay Reduction request form [PDF].

Complete the request form for a tier exception, and if medical necessity criteria are met and your request is approved, the copayment will be lowered to the preferred brand copayment on the plan until the end of the calendar year.

Medicare Part D guidance does NOT allow tier exceptions for brand-name medications for generic copayments. Failure to complete this form in its entirety may result in an adverse determination for insufficient information.

When completed, please fax completed form to 1 (866) 249-1172. Or submit by phone, by calling 1 (800) 558-9363.

Download the Copay Reduction request form [PDF]

Conflict of Interest Disclosure

Members may have conflicts of interest if they are Connecticut General Life Insurance Company Directors or Officers with Involvement in the Cigna Medicare Part D Prescription Drug Program, or employees of any Cigna Company with managerial responsibilities Related to the Cigna Medicare Part D Prescription Drug Program.

In these cases, members must complete a Conflict of Interest Disclosure and submit it to their compliance officer. They may mail it to the address below, or use Internal Routing Code: B4SRS.

Mailing Address:
___________, Compliance Officer
Medicare Part D
900 Cottage Grove Road, Wilde Bldg., B4SRS
Hartford, CT 06152

Download the Conflict of Interest Disclosure form [PDF]

Medicare Part D Pharmacy Manual

Learn more about the Preferred Cost Share Participating Pharmacy Program requirements for Medicare Part D.

Download Manual [PDF]