Cigna will ensure health plan benefit coverage and will lift the “refill-too-soon” edits on Part D drugs during a disaster. “Disasters” include a:
- Presidential emergency declaration
- Declaration of emergency or disaster by a Governor
- Presidential (major) disaster declaration
- Public health emergency announcement by the Secretary of Health and Human Services
Medicare Advantage Plans
Within a given period of time:
- Coverage of Medicare Parts A, B, and Supplemental plan benefits will be supplied at non-contracted facilities.
- Applicable requirements for gatekeeper referrals will be waived in full.
- Customers will get the same cost sharing at non-contracted facilities as they would at plan-contracted facilities.
- Changes that help the customer will be effective right away without the 30-day notice requirement.
- We will consider exceptions when required policy, contract, or other rules are not met as a result of this disaster, such as when a customer is displaced from their home and is not able to get non-emergency health care from a network health care provider.
In the event that our health plan cannot resume normal operations by the end of the public health emergency or state of disaster, we will notify the Centers for Medicare & Medicaid Services (CMS).
Medicare Part D Prescription Drug Plans
Cigna will decide as to how the “refill-too-soon” edits are lifted during a disaster or emergency, as long as access to Part D drugs is given at the point-of-sale. Cigna will continue to lift these edits until the end of a public health emergency, or the end of a declared disaster or emergency. In the case of a public health emergency, it ends when the emergency no longer exists or at the end of the 90-calendar-day period starting from the initial declaration, whichever occurs first.
For major disasters or emergencies, Cigna will:
- Pay attention to the closure of disaster or emergency incident periods listed on the Federal Emergency Management Agency (FEMA) website. If after 30-calendar-days from the initial declaration the incident period has not officially closed, Cigna is not required to extend the implementation of the “refill-too-soon” edits, but may consider an extension. Cigna will work with customers who inform us they are still impacted by the disaster or emergency.
- Make sure customers have access to covered Part D drugs dispensed at out-of-network pharmacies if it is not reasonable for customers to get covered Part D drugs at a network pharmacy, and when such access is not routine.
- Allow affected customers to get the maximum extended day supply if requested and available at the time of refill.