PDF PRESCRIPTION DRUG LIST CHANGES
[Pages:24]PRESCRIPTION DRUG LIST CHANGES
Cigna Pharmacy Management?
2018
The medications listed below are changing coverage (or cost levels) on Cigna's Prescription Drug List. Changes are listed by drug list name and by the date they begin.
If you're enrolled with Cigna, you can log into to find out how these changes may affect your specific plan.
STANDARD (CIGNA NATIONAL) PRESCRIPTION DRUG LIST
Start date of change*
Drug class
January 1, 2018 ANXIETY/DEPRESSION/BIPOLAR DISORDER
ASTHMA/COPD/RESPIRATORY
ATTENTION DEFICIT HYPERACTIVITY DISORDER
Medication not covered^
Anafranil Pamelor Parnate Tofranil Zyflo Zyflo CR Desoxyn Dexedrine
BLOOD PRESSURE/HEART MEDICATIONS CANCER DIABETES
GASTROINTESTINAL/HEARTBURN
Betapace Nilandron Invokamet, Invokamet XR Invokana Lantus, Lantus SoloStar, Toujeo SoloStar Novolin, Novolog Cortifoam, Uceris rectal foam
Lotronex Marinol omeprazole bicarbonate packets, 40-1100mg capsules Rowasa Uceris tablet
Generic and/or preferred brand alternatives
clomipramine nortriptyline tranylcypromine imipramine montelukast, zafirlukast, zileuton ER zileuton ER methamphetamine dextroamphetamine, dextroamphetamine ER sotalol tablets nilutamide Synjardy, Synjardy XR, Xigduo XR Farxiga, Jardiance Basaglar, Levemir, Tresiba Humalog, Humulin Anucort-HC, Colocort, Hemmorex-HC, hydrocortisone, Procto-Med HC, ProctoPak, Proctosol-HC, Proctozone-HC alosetron dronabinol omeprazole
mesalamine enema budesonide EC capsule
909015UPDATED_10/17/2017
STANDARD (CIGNA NATIONAL) PRESCRIPTION DRUG LIST (cont)
Start date of change*
Drug class
January 1, 2018 GASTROINTESTINAL/HEARTBURN (cont)
HORMONAL AGENTS INFECTIONS
MISCELLANEOUS PAIN RELIEF AND INFLAMMATORY DISEASE
PARKINSON'S DISEASE SCHIZOPHRENIA/ANTI-PSYCHOTICS
Medication not covered^
Zegerid Zofran Zofran ODT DDAVP Hectorol Augmentin, Augmentin ES, Augmentin XR
Diflucan E.E.S. 200, Eryped 400 Mepron Sporanox Targadox
Valcyte Vancocin Zovirax Gralise, Horizant Cambia
D.H.E. 45, Migranal Imitrex, Sumavel DosePro Lorzone OxyContin Roxicodone Tivorbex Vanatol LQ
Vivlodex Zomig Zorvolex Lodosyn Requip XL Geodon Zyprexa Zyprexa Zydis
Generic and/or preferred brand alternatives
omeprazole ondansetron ondansetron ODT desmopressin doxercalciferol capsule amoxicillin-clavulanate ER, amoxicillinclavulanate fluconazole erythromycin ethylsuccinate atovaquone itraconazole
Avidoxy tablet, doxycycline hyclate, Morgidox capsule valganciclovir
vancomycin capsule
acyclovir
gabapentin
diclofenac, diclofenac ER, etodolac, etodolac ER, fenoprofen, Fenortho, flurbiprofen, ibuprofen, indomethacin, indomethacin ER, ketoprofen, Ketorolac, meclofenamate, mefenamic acid, meloxicam, nabumetone dihydroergotamine
sumatriptan
chlorzoxazone
Embeda, Hysingla ER, Xtampza ER
oxycodone
indomethacin
butalbital/acetaminophen/caffeine tabs or caps meloxicam
sumatriptan, zolmitriptan
diclofenac, diclofenac ER
carbidopa
ropinirole ER
ziprasidone
olanzapine
olanzapine ODT
STANDARD (CIGNA NATIONAL) PRESCRIPTION DRUG LIST (cont)
Start date of change*
Drug class
January 1, 2018 SKIN CONDITIONS
SLEEP DISORDERS/SEDATIVES URINARY TRACT CONDITIONS
Start date of change*
January 1, 2018
Drug class
ALLERGY/NASAL SPRAYS ATTENTION DEFICIT HYPERACTIVITY DISORDER
SKIN CONDITIONS
Start date of change*
Drug class
January 1, 2018 GASTROINTESTINAL/HEARTBURN
HORMONAL AGENTS
Medication not covered^
Generic and/or preferred brand alternatives
Cutivate
fluticasone cream
Kenalog
triamcinolone spray
Locoid lotion
hydrocortisone butyrate
Luzu
ketoconazole cream
Soriatane
acitretin
Ziana
clindamycin-tretinoin
Nuvigil
armodafinil
Provigil
modafinil
Restoril
temazepam
Detrol
tolterodine
Detrol LA
tolterodine ER
Ditropan XL
oxybutynin ER
Enablex
darifenacin ER
Gelnique
darifenacin ER, oxybutynin ER, tolterodine ER, trospium ER
Non-preferred brand medication
Generic and/or preferred brand alternatives
Astepro
azelastine nasal spray
Adderall XR
dextroamphetamine-amphetamine ER
Focalin XR
dexmethylphenidate ER
Ala-Scalp
hydrocortisone
Analpram HC lotion
hydrocortisone-pramoxine
Capex shampoo
fluocinolone
Cordran
flurandrenolide
Differin
adapalene
Metrogel
metronidazole gel
Naftin
naftifine
Nucort, Texacort
hydrocortisone
Medication requiring prior authorization
Additional information
Akynzeo, Anzemet, Emend,
Your plan will only cover this medication if
Sancuso, Varubi
your doctor requests and receives approval
Androderm, Androgel, Striant, testosterone from Cigna.
Start date of change*
January 1, 2018
Drug class
ALLERGY/NASAL SPRAYS ALZHEIMER'S DISEASE ANXIETY/DEPRESSION/BIPOLAR DISORDER
ASTHMA/COPD/RESPIRATORY BLOOD PRESSURE/HEART MEDICATIONS CANCER EYE CONDITIONS
Medication with quantity limits Additional information
cromolyn oral, mometasone Namenda XR, Namzaric desvenlafaxine 25mg, 100mg, Marplan, Pristiq Perforomist Ranexa Fareston, nilutamide bimatoprost eye drops, Cystaran, Zioptan
Your plan only covers a certain amount of this medication over a certain number of days. Your plan will only cover a larger amount if your doctor requests and receives approval from Cigna.
STANDARD (CIGNA NATIONAL) PRESCRIPTION DRUG LIST (cont)
Start date of change*
January 1, 2018
Start date of change*
January 1, 2018
Drug class
HORMONAL AGENTS
MISCELLANEOUS OSTEOPOROSIS PRODUCTS PAIN RELIEF AND INFLAMMATORY DISEASE SCHIZOPHRENIA/ ANTI-PSYCHOTICS SEIZURE DISORDERS SKIN CONDITIONS SLEEP DISORDERS/SEDATIVES
Drug class
ATTENTION DEFICIT HYPERACTIVITY DISORDER SCHIZOPHRENIA/ANTI-PSYCHOTICS SKIN CONDITIONS
Medication with quantity limits Additional information
Alora, estradiol patch, Estring, Menostar, Minivelle, Vagifem, Vivelle-Dot, yuvafem Nuedexta alendronate Daliresp, Mitigare Fanapt
Your plan only covers a certain amount of this medication over a certain number of days. Your plan will only cover a larger amount if your doctor requests and receives approval from Cigna.
Gabitril, Potiga Denavir, Regranex, Santyl, Vectical Hetlioz
Step Therapy medication^^
Focalin XR
Generic and/or preferred brand alternatives
dexmethylphenidate ER
Orap Ala-Scalp Capex shampoo Cordran Nucort, Texacort
pimozide hydrocortisone fluocinolone flurandrenolide hydrocortisone
Start date of change*
Drug class
January 1, 2018 ALLERGY/NASAL SPRAYS
Medication strength with limitations++ (Your plan doesn't cover 2 capsules/tablets per day of this strength)
desloratadine ODT 2.5mg
Covered medication strength (Prescription must be for 1 capsule/tablet per day of this strength)
desloratadine ODT 5mg
ANXIETY/DEPRESSION/BIPOLAR DISORDER Fetzima ER 20mg
Fetzima ER 40mg
Fetzima ER 40mg
Fetzima ER 80mg
Trintellix 5mg
Trintellix 10mg
Trintellix 10mg
Trintellix 20mg
BLOOD PRESSURE/HEART MEDICATIONS Azor 5-20mg
Azor 10-40mg
Benicar 20mg
Benicar 40mg
Benicar HCT 20-12.5mg
Benicar HCT 40-25mg
Bystolic 10mg
Bystolic 20mg
Tekturna 150mg
Tekturna 300mg
Tekturna HCT 150-12.5mg
Tekturna HCT 300-25mg
CHOLESTEROL MEDICATIONS
Livalo 1mg
Livalo 2mg
Livalo 2mg
Livalo 4mg
DIABETES
Farxiga 5mg
Farxiga 10mg
PAIN RELIEF AND INFLAMMATORY DISEASE Uloric 40mg
Uloric 80mg
SCHIZOPHRENIA/ANTI-PSYCHOTICS
Latuda 60mg
Latuda 120mg
STANDARD (CIGNA NATIONAL) PRESCRIPTION DRUG LIST (cont)
Start date of change*
Drug class
January 1, 2018 SEIZURE DISORDERS
SLEEP DISORDERS/SEDATIVES
Medication strength with limitations++ (Your plan doesn't cover 2 capsules/tablets per day of this strength)
Aptiom 200mg Aptiom 400mg Fycompa 4mg Fycompa 6mg Trokendi XR 25mg Trokendi XR 100mg Silenor 3mg
Covered medication strength (Prescription must be for 1 capsule/tablet per day of this strength)
Aptiom 400mg Aptiom 800mg Fycompa 8mg Fycompa 12mg Trokendi XR 50mg Trokendi XR 200mg Silenor 6mg
PERFORMANCE PRESCRIPTION DRUG LIST
Start date of change*
January 1, 2018
Start date of change*
January 1, 2018
Start date of change*
January 1, 2018
Drug class
ALLERGY/NASAL SPRAYS ATTENTION DEFICIT HYPERACTIVITY DISORDER DIABETES GASTROINTESTINAL/HEARTBURN INFECTIONS PAIN RELIEF AND INFLAMMATORY DISEASE
SKIN CONDITIONS
Drug class
DIABETES GASTROINTESTINAL/HEARTBURN HORMONAL AGENTS
PAIN RELIEF AND INFLAMMATORY DISEASE
Drug class
ALLERGY/NASAL SPRAYS ALZHEIMER'S DISEASE ANXIETY/DEPRESSION/BIPOLAR DISORDER ASTHMA/COPD/RESPIRATORY
Non-preferred brand medication
Astepro Adderall XR Lantus, Lantus SoloStar, Toujeo SoloStar omeprazole bicarbonate packet, 40mg-1100mg capsule, 20mg-1100mg Eryped 400 OxyContin Vanatol LQ
Ala-Scalp Capex shampoo Cordran Differin Kenalog spray Locoid lotion Metrogel Naftin Nucort, Texacort
Medication requiring prior authorization
Lantus, Lantus SoloStar, Toujeo SoloStar Akynzeo, Anzemet, Emend, Sancuso, Varubi Androderm, Androgel, Axiron, Fortesta, Natesto, Striant, Testim, Testopel, testosterone, Vogelxo Roxicodone
Generic and/or preferred brand alternatives
azelastine nasal spray dextroamphetamine-amphetamine ER Basaglar, Tresiba, Levemir omeprazole
erythromycin Embeda, Hysingla ER, Xtampza ER butalbital/acetaminophen/caffeine tabs or caps hydrocortisone topical fluocinolone scalp flurandrenolide topical adapalene triamcinolone spray hydrocortisone butyrate metronidazole gel naftifine hydrocortisone
Additional information
Your plan will only cover this medication if your doctor requests and receives approval from Cigna.
Medication with quantity limits Additional information
cromolyn oral, mometasone, Nasonex Namenda XR, Namzaric desvenlafaxine 25mg, 100mg, Marplan, Pristiq Perforomist
Your plan only covers a certain amount of this medication over a certain number of days. Your plan will only cover a larger amount if your doctor requests and receives approval from Cigna.
PERFORMANCE PRESCRIPTION DRUG LIST (cont)
Start date of change*
January 1, 2018
Start date of change*
January 1, 2018
Start date of change*
January 1, 2018
Drug class
BLOOD PRESSURE/HEART MEDICATIONS CANCER DIABETES EYE CONDITIONS HORMONAL AGENTS INFECTIONS MISCELLANEOUS OSTEOPOROSIS PRODUCTS PAIN RELIEF AND INFLAMMATORY DISEASE SCHIZOPHRENIA/ANTI-PSYCHOTICS SEIZURE DISORDERS SKIN CONDITIONS SLEEP DISORDERS/SEDATIVES
Drug class
ATTENTION DEFICIT HYPERACTIVITY DISORDER
SCHIZOPHRENIA/ANTI-PSYCHOTICS
SKIN CONDITIONS SLEEP DISORDERS/SEDATIVES
Drug class
ALLERGY/NASAL SPRAYS ANXIETY/DEPRESSION/BIPOLAR DISORDER
BLOOD PRESSURE/HEART MEDICATIONS
CHOLESTEROL MEDICATIONS
DIABETES
Medication with quantity limits Additional information
Ranexa Fareston, Nilandron, nilutamide Jentadueto, Tradjenta bimatoprost eye drops, Cystaran, Zioptan Alora, estradiol patch, Estring, Menostar, Minivelle, Vagifem, Vivelle Dot, yuvafem Zovirax Nuedexta alendronate Daliresp, Mitigare Abilify Maintena, Aristada, Fanapt, Invega Trinza, Risperdal Consta, Zyprexa Relprevv Gabitril, Potiga Denavir, Regranex, Santyl, Vectical, Zyclara Hetlioz
Step Therapy medication^^
Adderall XR Focalin XR Abilify Orap Locoid lotion Silenor
Medication strength with limitations++ (Your plan doesn't cover 2 capsules/tablets per day of this strength)
desloratadine ODT 2.5mg Fetzima ER 20mg Fetzima ER 40mg Trintellix 5mg Trintellix 10mg Azor 5-20mg Benicar 20mg Benicar HCT 20-12.5mg Bystolic 10mg Tekturna 150mg Tekturna HCT 150-12.5mg Livalo 1mg Livalo 2mg Farxiga 5mg
Your plan only covers a certain amount of this medication over a certain number of days. Your plan will only cover a larger amount if your doctor requests and receives approval from Cigna.
Generic and/or Preferred Brand Alternatives
dextroamphetamine-amphetamine ER dexmethylphenidate ER aripiprazole pimozide hydrocortisone butyrate eszopiclone, zolpidem
Covered medication strength (Prescription must be for 1 capsule/tablet per day of this strength)
desloratadine ODT 5mg Fetzima ER 40mg Fetzima ER 80mg Trintellix 10mg Trintellix 20mg Azor 10-40mg Benicar 40mg Benicar HCT 40-25mg Bystolic 20mg Tekturna 300mg Tekturna HCT 300-25mg Livalo 2mg Livalo 4mg Farxiga 10mg
PERFORMANCE PRESCRIPTION DRUG LIST (cont)
Start date of change*
Drug class
January 1, 2018 PAIN RELIEF AND INFLAMMATORY DISEASE SCHIZOPHRENIA/ANTI-PSYCHOTICS SEIZURE DISORDERS
SLEEP DISORDERS/SEDATIVES
Medication strength with limitations++ (Your plan doesn't cover 2 capsules/tablets per day of this strength)
Uloric 40mg Latuda 60mg Aptiom 200mg Aptiom 400mg Fycompa 4mg Fycompa 6mg Trokendi XR 25mg Trokendi XR 100mg Silenor 3mg
Covered medication strength (Prescription must be for 1 capsule/tablet per day of this strength)
Uloric 80mg Latuda 120mg Aptiom 400mg Aptiom 800mg Fycompa 8mg Fycompa 12mg Trokendi XR 50mg Trokendi XR 200mg Silenor 6mg
VALUE PRESCRIPTION DRUG LIST
Start date of change*
January 1, 2018
Start date of change*
January 1, 2018
Drug class
ALLERGY/NASAL SPRAYS ASTHMA/COPD/RESPIRATORY ATTENTION DEFICIT HYPERACTIVITY DISORDER DIABETES
PAIN RELIEF AND INFLAMMATORY DISEASE
SKIN CONDITIONS
Drug class
DIABETES GASTROINTESTINAL/HEARTBURN HORMONAL AGENTS PAIN RELIEF AND INFLAMMATORY DISEASE
Non-preferred brand medication
Astepro Spiriva, Spiriva Respimat Stiolto Respimat Adderall XR Focalin XR Apidra Invokamet, Invokamet XR Invokana Kombiglyze XR, Onglyza
Toujeo D.H.E. 45 Imitrex OxyContin Vanatol LQ
Zomig nasal spray Differin Metrogel Naftin
Medication requiring prior authorization
Lantus, Lantus SoloStar, Toujeo SoloStar Akynzeo, Anzemet, Emend capsule, powder packet, tripack, Sancuso, Varubi Androderm, Androgel, Axiron, Fortesta, Natesto, Striant, Testim, Testopel, testosterone, Vogelxo Roxicodone
Generic and/or preferred brand alternatives
azelastine nasal spray Incruse Ellipta Anoro Ellipta dextroamphetamine-amphetamine ER dexmethylphenidate ER Humalog Synjardy, Synjardy XR, Xigduo XR Farxiga, Jardiance alogliptin, alogliptin-metformin, Janumet, Janumet XR, Januvia Basaglar, Tresiba, Levemir dihydroergotamine sumatriptan Embeda, Hysingla ER, Xtampza ER butalbital/acetaminophen/caffeine tabs or caps sumatriptan, zolmitriptan adapalene metronidazole gel naftifine
Additional information
Your plan will only cover this medication if your doctor requests and receives approval from Cigna.
VALUE PRESCRIPTION DRUG LIST (cont)
Start date of change*
January 1, 2018
Drug class
ALLERGY/NASAL SPRAYS ALZHEIMER'S DISEASE ANXIETY/DEPRESSION/BIPOLAR DISORDER ASTHMA/COPD/RESPIRATORY BLOOD PRESSURE/HEART MEDICATIONS
Medication with quantity limits Additional information
cromolyn oral, Nasonex, mometasone Namenda XR, Namzaric desvenlafaxine ER, Marplan, Pristiq Perforomist Ranexa
Your plan only covers a certain amount of this medication over a certain number of days. Your plan will only cover a larger amount if your doctor requests and receives approval from Cigna.
CANCER
Fareston, Nilandron, nilutamide
DIABETES
Jentadueto, Tradjenta
EYE CONDITIONS
bimatoprost, Cystaran, Zioptan
HORMONAL AGENTS INFECTIONS
Alora, estradiol patch, Estring, Menostar, Minivelle, Vagifem, Vivelle-Dot, yuvafem
Zovirax
MISCELLANEOUS
Nuedexta
OSTEOPOROSIS PRODUCTS
alendronate
PAIN RELIEF AND INFLAMMATORY DISEASE Daliresp, Mitigare
SCHIZOPHRENIA/ANTI-PSYCHOTICS
Fanapt
SEIZURE DISORDERS
Gabitril, Potiga
SKIN CONDITIONS
Denavir, Regranex, Santyl, Vectical, Zyclara
SLEEP DISORDERS/SEDATIVES
Hetlioz
Start date of change*
January 1, 2018
Start date of change*
January 1, 2018
Drug class
ATTENTION DEFICIT HYPERACTIVITY DISORDER DIABETES SCHIZOPHRENIA/ANTI-PSYCHOTICS SKIN CONDITIONS SLEEP DISORDERS/SEDATIVES
Drug class
ANXIETY/DEPRESSION/BIPOLAR DISORDER
BLOOD PRESSURE/HEART MEDICATIONS
Step Therapy medication^^
Adderall XR Focalin XR Invokamet, Invokamet XR Invokana Abilify Orap Locoid lotion Silenor
Medication strength with limitations++ (Your plan doesn't cover 2 capsules/tablets per day of this strength)
Fetzima ER 20mg Fetzima ER 40mg Trintellix 5mg Trintellix 10mg Azor 5-20mg Benicar 20mg Benicar HCT 20-12.5mg
Generic and/or preferred brand alternatives
dextroamphetamine-amphetamine ER dexmethylphenidate ER Synjardy, Synjardy XR, Xigduo XR Farxiga, Jardiance aripiprazole pimozide hydrocortisone butyrate zolpidem, eszopiclone
Covered medication strength (Prescription must be for 1 capsule/tablet per day of this strength)
Fetzima ER 40mg
Fetzima ER 80mg
Trintellix 10mg
Trintellix 20mg
Azor 10-40mg
Benicar 40mg
Benicar HCT 40-25mg
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