Cigna will ensure health plan benefit coverage and will lift the “refill-too-soon” edits on Part D drugs when there are circumstances that could reasonably result in disruption of access to your Medicare Advantage health plan benefits or covered Part D drugs in the event of 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
The following safeguards are in place so that effected customers do not suffer unnecessary hardship:
Medicare Advantage Plans
- Coverage of Medicare Parts A, B, and supplemental Part C plan benefits will be furnished at non-contracted facilities within a specified period of time.
- Applicable requirements for gatekeeper referrals will be waived in full during a specified time.
- Customers will receive the same cost sharing at non-contracted facilities as they would at plan-contracted facilities during a specified period of time.
- Changes that benefit the customer will be effective immediately without the 30-day notification requirement during time specified.
- We will consider exceptions when required policy, contract, or other rules are not met as a result of this disaster, including where a customer is displaced from their home and is unable to obtain non-emergency medical services 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 Centers for Medicare & Medicaid Services (CMS).
Medicare Part D Prescription Drug Plans
Cigna will exercise some operational discretion as to how the “refill-too-soon” edits are lifted during a disaster or emergency, as long as access to Part D drugs is provided at the point-of-sale. Cigna will continue to lift these edits until the termination of a public health emergency, or the end of a declared disaster or emergency. In the case of a public health emergency, it terminates when the emergency no longer exists or upon the expiration of the 90-calendar-day period beginning from the initial declaration, whichever occurs first.
For major disasters or emergencies, Cigna will:
- Pay particular attention to the closure of disaster or emergency incident periods listed on the Federal Emergency Management Agency (FEMA) website. If 30-calendar-days from the initial declaration the incident period has not officially closed, Cigna is not required to extend the implementation of the edits, but may consider the extension. Cigna will work closely with customers who indicate they are still displaced or otherwise impacted by the disaster or emergency.
At all times, and especially in disaster and/or public health emergency situations, Cigna will ensure customers have adequate access to covered Part D drugs dispensed at out-of-network pharmacies if it is not reasonable for customers to obtain covered Part D drugs at a network pharmacy, and when such access is not routine. In addition, Cigna will always allow an affected customer to obtain the maximum extended day supply if requested and available at the time of refill.