ADDITIONAL 2017 FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS
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- Chastity Houston
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1 ADDITIONAL 2017 FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS Effective 7/1/2017, Cigna will be making additional formulary changes that may impact customers at your pharmacy. We have included a list of drugs by drug class that will be considered non-covered, nonpreferred brand or require approval from Cigna for coverage, as well as the covered alternatives. We sent letters to the customers explaining the changes to their current medications. However, if a customer with Cigna pharmacy benefits does come in and attempts to refill a medication that is not covered, when appropriate, we ask that you assist him or her in the following ways: Mention the alternative covered drugs available in the chart below Urge the customer to meet with the prescriber to discuss these alternatives or please call the prescriber to facilitate the new prescription Help the customer fill out the simple form below to bring to his or her prescriber If you have questions, please see below: Question: Point of Service and Processing Phone Number: Issue Type: 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 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel- Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc Cigna. 01/17
2 Drug Coverage Changes by Class Please note that this list only applies to our non-medicare Standard Prescription Drug List and does not reflect the entire list of covered and not-covered drugs for this or any other Cigna drug list. Drug class Non-preferred Generic and/or preferred brand** medication** brand alternatives Infections Daklinza + Epclusa +, Harvoni +, Sovaldi + Generic and/or preferred Drug class Medication not covered^ brand alternatives Cardizem diltiazem Blood Pressure/ Heart Isordil Titradose isosorbide dinitrate Lanoxin digitek, digox, digoxin Cholesterol Antara, Fenoglide fenofibrate Cough/Cold hydrocodone-chlorpheniramne ER, Tussicaps promethazine-codeine Diuretics Edecrin, ethacrynic acid bumetanide,furosemide, torsemide anucort-hc, Grx Hicort 25, Anusol-HC suppository hemmorex-hc, hydrocortisone, rectacort HC Gastrointestinal/ Heartburn Omeclamox- pak, Prevpac, Pylera lansoprazole-amoxicilin-clarithromycin (combo pak) Hormonal Agents Dexpak dexamethasone Infections Onmel itraconazole, terbinafine Conzip tramadol, tramadol ER Skin Conditions Levorphanol tartate Naprelan, naproxen CR, naproxen ER, Zipsor Zomig ZMT Aldara Anusol-HC cream Clobex Ertaczo Extina Halog Locoid lipocream Loprox Oxistat Penlac acetaminophen-codeine, hydrocodone acetaminophen, hydromorphone ER, hydromorphone, lorcet, lorcet HD, lorcet plus, oxycodone, oxycodone ER, tramadol, verdrocet, vicodin, vicodin ES, vicodin HP diclofenac, diclofenac ER, etodolac, etodolac ER, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, meloxicam, nabumetone, naproxen, naproxen DS, oxaprozin, piroxicam, sulindac, tolmentin zolmitriptan ODT imiquimod hydrocortisone, protco-med HC proctosol-hc, proctozone-hc clobetasol, clodan shampoo ketoconazole ketoconazole, ketodan clobetasol propionate, halobetasol propionate hydrocortisone butyrate ciclodan, ciclopriox clotrimazole econazole nitrate, ketoconazole, oxiconazole nitrate Ciclodan, ciclopirox
3 Sleep Disorders/ Sedatives Plexion Prudoxin Salex Trianex Ultravate Ultravate X Verdeso Vusion Zonalon Ambien Ambien CR sulfacetamide-sulfur, SS 10-2, Zencia doxepin salicylic acid Triamcinolone acetonide, triderm Ala-cort, alclometasone dipropionate, aminonide, apexicon, betamethasone dipropinate, betamethasone valerate, clobetasol emollient, clobetaslon emulsion, clobetasol propionate, clocortonlone pivalate, clodan, cormax, desonide, desoximetasone, diflorasone diacetate, fluocinolene acetonide, fluocinonide, fluocinonide- E, flurandrenolide, fluticasone propionate, halobetasol propionate, hydrocortisone, hydrocortisone butyrate, hydrocortisone valerate, micort-hc, mometasone furoate, prednicarbate, psorcon, scalacort, tacrolimus, triamcinolone acetonide, trianex, triderm clobetasol propionate, halobetasol propionate desonide ketoconazole doxepin, prudoxin zolpidem zolpidem ER Drug class Medication requiring prior authorization Additional information Miscellaneous Syprine acetaminophen-codeine, ascomp with codeine, aspirin-caffeine-dihydrocodeine, belladonna-opium, butalbital-acetaminophen caffeine-codeine, butalbital-caffeineacetaminophen codeine, butalbital compoundcodeine, butorphanol, carisoprodol compound-codeine, carisoprodol-aspirincodeine, codeine, Demerol, dihydrocodeineacetaminophen-caffeine, Dilaudid, Duragesic, Embeda, Endocet, Exalgo, fentanyl patch, Fioricet with Codeine, Hycet, hydrocodoneacetaminophen, hydrocodone ibuprofen,hydromorphone, hydromorphone ER, Hysingla ER, Ibudone, Kadian ER, levorphanol tartrate, Lorcet, Lorcet HD, Lorcet Plus, Lortab, meperidine, morphine sulfate, morphine sulfate ER, MS Contin, norco, Nucynta, Nucynta ER, Opana, Opana ER, Oxaydo, oxycodone acetaminophen, oxycodone-aspirin, oxycodone-ibuprofen, oxycodone, oxycodone ER, oxymorphone ER, oxymorphone, Oxycontin, pentazocinenaloxone, Percocet, Primlev, Reprexain, Roxicodone, Synalgos-DC, trezix, Tylenolcodeine, Verdrocet, Vicodin, Vicodin ES, Vicodin HP, Xartemis XR,Xodol, Xtampza ER, Xylon 10, Zamicet, Zohydro ER Ask your doctor to call us. Your plan will only cover your medication if your doctor requests and receives approval from Cigna.
4 Drug class Cough/ Cold Gastrointestinal/ Heartburn Substance Abuse Cuprimine, Depen Titratab Medication with quantity limits Flowtuss, hycofenix, Hydrocod-cpmpseudoephedrine, Hydrocodone BThomatropine, Hydrocodone-chlorpheniramne ER, Hydrocodone-homatropine, hydromet, obredon, Promethazine VC-codeine, Promethazine-codeine, Promethazinephenyleph-codeine, Rezira, Tussicaps, Tussigon, Tussionex, Tuzistra XR, Vituz, Zutripro Opium Tincture Evzio, Naltrexone Abstral, acetaminophen-codeine, actiq, alfentanil, ascomp with codeine, aspirincaffeine- dihydocodeine, belladonna- opium, butalbital-acetaminophen-caffeine- codeine, butalbital-caffeine-acetaminophen-codeine, butalbital compound-codeine, butalbitalacetaminophen-caffeine, butalbital-aspirincaffeine, butorphanol, capacet, carisoprodol compound-codeine, carisoprodol-aspirincodeine, codeine, Demerol, dihydrocodeineacetaminophen-caffeine, Dilaudid, duramorph, Endocet, esgic, fentanyl patch, fentanylbupivacacaine, fentora, fioricet, fioricet with codeine, fiorinal, finorinal with codeine, hycet, hydrocodone-acetaminophen, hydrocodoneibuprofen, hydromorphone, Ibudone, infumorph, ionsys, lazanda, levorphanol, Lorcet, Lorcet HD, Lorcet Plus, Lortab, meperidine, morphine, nalbuphine, norco, Nucynta, Nucynta ER, Opana, Oxaydo, oxycodone, oxycodone-aspirin, oxycodoneibuprofen, oxycodone-acetaminophen, oxymorphone, pentazocine-naloxone, Percocet, Primlev, Reprexain, Roxicodone, subsys, sufentanil, Synalgos- DC, talwin, trezix, Tylenol-codeine, ultiva, Verdrocet, Vicodin, Vicodin ES, Vicodin HP, Xodol,10-300, xodol 5-300, xodol , Xylon 10, zamicet, zebutal Additional information Your plan only covers a certain amount of this medication. If your doctor writes a prescription for an amount more than what s allowed, it will only be covered in that amount if your doctor requests and receives approval from Cigna. * Drug is not covered unless approved through a medical necessity review. Customers should speak with their provider about switching to a covered alternative drugs. ^ In Step Therapy, customers must try the most cost-effective, appropriate drugs available before their plan approves more expensive brand name drugs.
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