SPECIALTY PHARMACY DRUG LIST
July 2015
Specialty medications are used to treat complex conditions like multiple sclerosis, hepatitis C and rheumatoid arthritis. Although some are oral medications, the majority of specialty drugs are injected and may require special handling (e.g. refrigeration). As part of your pharmacy benefits plan, you have access to Cigna Specialty Pharmacy Services to deliver these medications.
How it works prescription at an out-of-network pharmacy, but your out-of-pocket cost will likely be much higher. When your doctor prescribes a specialty medication, they’ll call in or fax the prescription to: Please note: Some medications listed here may need to be obtained through your doctor’s office or other Cigna Specialty Pharmacy Services medical facility. In these cases, your medications will 800.351.3606 (phone) be covered under your medical benefit instead of your 800.351.3616 (fax) pharmacy benefit. This will affect the amount you pay Cigna Specialty Pharmacy Services creates a out-of-pocket. Check your plan documents for personalized experience that educates and motivates more information. each customer to become active, accountable and confident. We offer the tools to connect and engage Health care reform and you you along your health care journey. Our services include The Patient Protection and Affordable Care Act 24-hour access to nurses and pharmacists, education (PPACA), commonly referred to as “health care reform,” about your prescription medications and refill reminders. was signed into law on March 23, 2010. This important Once your prescription order is received and processed, legislation will result in changes to every American’s we’ll call you to schedule a date and time for delivery. health coverage. Some of the changes took effect in Orders will be delivered to any address you choose for 2010, and most of the law’s effects will be felt by 2014. delivery (e.g., home, office, doctor’s office). Cigna will comply with all provisions of the law including For all proactive refills or any orders over $4,000, those that impact your pharmacy coverage plan. For delivery arrangements need to be made and confirmed example, depending upon the final government with our pharmacy before we can send them to you. regulations, coverage for medications that have not traditionally been included in pharmacy plans, such as If the pharmacy is not able to reach you, they’ll leave a specific over-the-counter (OTC) medications, may be message for you to call them back. The pharmacy can’t made available at no cost share to you. As with all deliver the medications without your approval, so covered medications, we require a delivery will be delayed until you reply. prescription from your doctor to process the claim under If you need to fill your prescription right away, you may your pharmacy plan (including OTC medications). be able to fill your prescription at a local network retail pharmacy. However, you’ll only get up to a 30-day To get the most current information, visit supply and must fill the rest of your prescription InformedOnReform.com or Cigna.com and look for through Cigna Specialty Pharmacy Services. If your the “Informed on Reform” link. plan offers out-of-network coverage, you can get your
Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affiliates. 827113 n 04/15 Questions? Below is a list of medications that must be filled through Cigna Specialty Pharmacy Services to be covered under your pharmacy benefit.Please note: This list is subject to change. For more information, you can visit myCigna.com or call customer service using the number on the back of your ID card at any time, and we’ll be happy to help.
Specialty Drugs A Atgam Cellcept (Oral)* Docefrez F Abacavir* Atripla* Ceprotin Docetaxel Fabrazyme* Abraxane Atryn Cerdelga* Doxil Farydak Actemra* Aubagio* Cerezyme* Doxorubicin Faslodex Acthar H.P.* Avastin Cetrotide Dysport* Feiba NF* Acthrel Avonex* Chorionic Fertinex Gonadotropin E Actimmune* Azacitidine Firazyr* Cidofovir Edurant* Adagen Azasan* Firmagon Cimzia* Egrifta* Adcetris Azathioprine* Flebogamma DIF Cinryze Elaprase Adcirca* Flolan B Cisplatin Elelyso* Adefovir Dipivoxil* Floxuridine Baraclude* Cladribine Eligard* Adempas Fludarabine Baygam* Clolar Elitek Adrucil Fludarabine BCG Vaccine Combivir* Ellence Phosphate Advate* (Tice Strain) Cometriq* Eloctate* Fluorouracil Afinitor Disperz* Bebulin* Complera* Eloxatin Flutamide* Afinitor* Beleodaq Copaxone* Elspar Follistim AQ Agrylin* Benefix* Copegus* Emcyt* Folotyn Akynzeo Benlysta Corifact Emend Fondaparinux Aldurazyme* Berinert Cosentyx* Emtriva* Fondaparinux Alferon N* Betaseron* Cosmegen Enbrel* Sodium Alimta Bethkis Crixivan* Enoxaparin Forteo* Alkeran Bicalutamide* Cyclophosphamide* Entecavir* Fragmin Aloxi Bicnu Cyclosporine Entyvio Fudr Alphanate* Bivigam* Cyclosporine (Oral)* Epirubicin Fusilev Alphanine SD* Bleomycin Sulfate Cyklokapron Epivir HBV* Fuzeon* Alprolix* Blincyto Cyramza Epivir* Amifostine Boniva* G Cystadane* Epogen Aminocaproic Acid* Bosulif* Gamastan S-D* Cystagon Epoprostenol Ampyra* Botox* Sodium Gammagard Liquid* Cytarabine Anagrelide HCl* Bravelle Epzicom* Gammagard S-D* Cytogam Anzemet Busulfex Erbitux Gammagard* Cytovene Apokyn* Erivedge* Gammaked* C Aptivus* D Erwinaze Gammaplex Camptosar Aralast Dacarbazine Esbriet* Gamunex-C* Capecitabine* Aralast NP Dacogen Etopophos Ganciclovir Caprelsa Aranesp Daunorubicin Etoposide Ganciclovir Sodium Carboplatin Arcalyst Daunoxome Euflexxa* Ganirelix Acetate Carimune NF Argatroban Gattex Nanofiltered DDAVP Evotaz* Arixtra Gazyva Casodex* Decitabine Exjade Arranon Gel-One* Cayston Depocyt Extavia* Arzerra Gemcitabine Cellcept Desmopressin Eylea Astagraf XL* Didanosine* Gemcitabine HCl
2 Gemzar Imuran* Leuprolide* Neupogen Plegridy* Gengraf* Incivek* Lexiva* Nevirapine* Pomalyst* Genotropin* Increlex Lipodox Nevirapine ER* Pregnyl Gilenya* Inlyta* Lipodox 50 Nexavar* Prezcobix* Gilotrif Intelence* Lovenox Nexavir Prezista* Glassia Intron A* Lucentis Nipent Prialt Gleevec* Invirase* Lumizyme Norditropin* Privigen* Gliadel Wafer Iprivask* Lupaneta Northera Procrit Gonal-F Irinotecan Lupron Depot* Norvir* Procysbi DR Gonal-F RFF Irinotecan HCl Lutrepulse Novarel Profasi Granix Isentress* Lynparza Novoeight* Profilnine SD* Istodax Lysteda Novoseven* Prograf H Ixempra Nplate Prograf (Oral)* Halaven M Nulojix Prolastin C Harvoni* J Macugen Nutropin AQ* Proleukin Hecoria* Jakafi Marqibo Kit Prolia Helixate FS* Jetrea* Matulane O Promacta* Hemofil M* Jevtana* Mekinist* Obizur Provenge Hepagam B Juxtapid* Melphalan HCl Octagam* Provisc* Hepsera* Menopur Octreotide Acetate* K Pulmozyme* Herceptin Mesna Ofev Kadcyla Purixan Hexalen* Mesnex Olysio* Kalbitor Hizentra* Methotrexate Omnitrope* R Kaletra* HP Acthar* Methotrexate Oncaspar Rapamune* Kalydeco* Humate-P* (Oral)* Onxol Rasuvo Kcentra Humatrope* Micrhogam Opdivo Rebetol* Kcentra Kit Humira* Mircera Opsumit Rebif* Kepivance Hyalgan* Mitomycin Orencia* Rebif Rebidose* Keytruda Hycamtin* Mitoxantrone HCl Orenitram ER Reclast* Kineret* Hylenex* Moderiba* Orfadin Recombinate* Kitabis Pak Hyperhep B S-D Monoclate-P* Orthovisc* Remicade* Koate-DVI* Hyperrab S-D Mononine* Otezla* Remodulin Kogenate FS* Hyperrho S-D Monovisc* Otrexup Rescriptor* Krystexxa Hyqvia Mustargen Ovidrel Retrovir Kuvan* Myalept Oxaliplatin Retrovir (Oral)* I Kynamro Mycophenolate* Revatio* Ibandronate* Kyprolis P Mycophenolic Acid* Revlimid* Ibrance* Myfortic* Paclitaxel L Reyataz* Iclusig* Myobloc Pamidronate Disod* Lamivudine* Rheumatrex Idamycin PFS Myozyme Pamidronate* Lamivudine - Rhogam Plus Idarubicin HCl Panretin* Zidovudine* Rhophylac Ifex N Paricalcitol Lemtrada* Riastap Ifosfamide Nabi-HB Paricalcitol (Oral)* Lenvima Ribapak* Ifosfamide-Mesna Naglazyme Pegasys Proclick* Letairis* Ribasphere* Ilaris Natrecor Pegasys* Leucovorin Ribatab* Iluvien Calcium (Oral)* Navelbine Pegintron* Ribavirin* Imbruvica* Leukine Neoral* Perjeta Rilutek* Imogam Rabies-HT Leuprolide Acetate* Neulasta* Photofrin Neumega Riluzole*
3 Rituxan Supprelin* Toposar Vimizim Xtandi* Rixubis* Sustiva* Topotecan HCl* Vinblastine Sulfate Xyntha* Ruconest Sutent* Topotecan* Vincasar PFS Xyntha Solofuse* Sylatron* Torisel Vincristine Xyrem S Sylvant Tracleer* Vincristine Sulfate Sabril Y Synagis* Tranexamic Acid Vinorelbine Saizen* Yervoy Synarel* Treanda Vinorelbine Tartrate Sandimmune Synribo* Trelstar* Viracept* Z Sandimmune (Oral)* Synvisc* Tretten Viramune XR* Zaltrap Sandostatin LAR* Synvisc-One* Trexall* Viramune* Zanosar Trisenox Virazole* Zavesca Sandostatin* T Triumeq* Viread* Zelboraf* Selzentry* Tacrolimus* Trizivir* Vistide Zemaira Sensipar Tafinlar* Truvada* Visudyne Zemplar Serostim* Tarceva* Tybost* Vitekta* Zemplar (Oral)* Signifor Targretin* Tykerb* Vivitrol* Zerit* Sildenafil* Tasigna* Tysabri* Voraxaze Zevalin Simponi Aria* Taxotere Tyvaso Votrient* Ziagen* Simponi* Tecfidera* Tyzeka* Vpriv* Zidovudine* Simulect Temodar Zoladex* Sirolimus* Temodar (Oral)* V W Zoledronic Acid* Soliris Temozolomide* Valchlor Wilate* Zolinza Somatuline Depot Teniposide Valstar Winrho SDF* Zometa* Somavert Tev-Tropin* Vantas* X Zorbtive* Sovaldi* Thalomid* Vectibix Xalkori* Zortress* Sprycel* Theracys Velcade Xeljanz* Zydelig Stavudine* Thrombate III Veletri Xeloda* Zykadia* Stelara* Thymoglobulin Ventavis Xenazine Zytiga* Stimate Thyrogen Victrelis* Xeomin* Stivarga* Tivicay* Vidaza Xgeva Stribild* Tobi* Videx* Xiaflex* Sucraid Tobi Podhaler* Videx EC* Xolair* Supartz* Tobramycin* Viekira*
* These medications must be obtained from a preferred specialty pharmacy. Only your first prescription can be obtained at a network retail pharmacy. All subsequent refills must be obtained through a preferred specialty pharmacy. To maximize your benefits, all other medications are available through Cigna Specialty Pharmacy Services, at a network retail pharmacy or through your doctor’s office, if necessary. ^ Check your plan materials to determine if this Growth Hormone medication is covered under your plan.
“Cigna” and the “Tree of Life” logo are registered service marks, and “Cigna Home Delivery Pharmacy” and “Together, all the way.” are service marks, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO subsidiaries of Cigna Health Corporation. “Cigna Specialty Pharmacy Services” refers to the specialty drug division of Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C., doing business as Cigna Home Delivery Pharmacy. All models are used for illustrative purposes only. 827113 n 04/15 © 2015 Cigna. Some content provided under license.