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Exclusive Cigna Home Delivery Pharmacy drug list

If your prescription drug plan includes Exclusive Cigna Home Delivery Pharmacy, you are required to fill maintenance medication prescriptions (medications taken on an regular basis) through Cigna Home Delivery PharmacySM. Depending on your benefit plan, you are typically allowed three fills before you are required to use Cigna Home Delivery Pharmacy. At that time, if you choose not use Cigna Home Delivery Pharmacy, your plan will not cover the cost of your medication. To see real-time drug pricing, visit myCigna.com and use the Prescription Drug Price Quote tool to search for medications and compare pricing for your selected medications and lower-cost alternatives. The tool provides guidance on options you can discuss with your doctor and shows annual savings when you use Cigna Home Delivery Pharmacy. In addition to cost savings, Cigna Home Delivery Pharmacy offers valuable benefits, such as: • Licensed pharmacists available 24/7 • Up to a 90-day supply of medications in one fill • Standard delivery at no additional cost • Reminders if you forget to fill your prescriptions • Specialty medications, including those that require refrigeration and overnight delivery The following is a list of medications that apply to your Exclusive Cigna Home Delivery Pharmacy plan. Refer to your enrollment materials to understand the medications covered under your plan and to see if there are any requirements such as prior authorization (PA), quantity limits (QL) or Step Therapy (ST), as well as those requiring use of Cigna Home Delivery Pharmacy.

If you have questions We’re here to help. Just call us at the toll-free number on your ID card and we will be happy to answer your questions.

834176 c 05/13 Drug Name (generic name products are Drug Name (generic name products are Drug Class generally lowercase) Drug Class generally lowercase) ADD/ADHD Strattera Birth Control Enpresse (Continued) Errin Allergy Astepro Estrostep FE azelastine Femcon FE Beconase AQ Generess FE hcl Gianvi desloratadine Jolessa Dymista Jolivette flunisolide Junel fluticasone propionate Kariva (nasal) Kelnor Nasonex Lessina Omnaris Loestrin 24 FE Patanase Low-Ogestrel Rhinocort Aqua Loseasonique triamcinolone acetonide (nasal) Lutera Veramyst Microgestin QNASL Micronor Xyzal Modicon Zetonna Natazia Alzheimer’s Disease donepezil Necon Exelon Nortrel galantamine hydrobromide Nuvaring Namenda Ocella pyridostigmine Ogestrel rivastigmine (caps) Ortho Evra Ortho TriCyclen Asthma Advair Ortho TriCyclen Lo Aerobid Ortho-Cyclen albuterol Ortho-Novum alupent Orsythia Alvesco Ovcon aminophylline Portia Arcapta Seasonique Asmanex Seasonale Atrovent HFA Sprintec Brovana Tri-Sprintec budesonide (inhaler) Yasmin Combivent Yaz cromolyn sodium Dulera Bladder Problems Enablex Flovent hcl Foradil Gelnique Transdermal ipratropium bromide Myrbetriq ipratropium-albuterol chloride levalbuterol hcl Oxytrol Transdermal Lufyllin Toviaz Maxair Autohaler trospium chloride montelukast Perforomist Urocit-K Pulmicort Vesicare Qvar Blood Thinner/ Aggrenox Serevent Diskus Anti-Clotting cilostazol Spiriva clopidogrel Symbicort dipyridamole Tudorza Pressair Effient terbutaline sulfate Eliquis theophylline Pradaxa zafirlukast ticlopidine hcl Zyflo Trental Birth Control Amethia warfarin Aranelle Xarelto * Please check your enrollment BeYaz Cancer anastrozole Briellyn exemestane materials to determine whether Camila fareston these medications are covered Cyclessa faslodex under your specific plan. Demulen letrozole Desogen tamoxifen citrate 2 Drug Name (generic name products are Drug Name (generic name products are Drug Class generally lowercase) Drug Class generally lowercase) Cardiovascular acebutolol hcl Cardiovascular methyclothiazide amiloride (Continued) methyldopa amiloride-hydrochlorothiazide methyldopa-hydrochlorothiazide amiodarone metolazone amlodipine besylate metoprolol amlodipine/benazepril metoprolol-hydrochlorothiazide Amturnide mexiletine hcl atenolol Micardis atenolol/chlorthalidone Micardis HCT Azor minoxidil benazepril hcl moexipril benazepril-hydrochlorothiazide moexipril-hydrochlorothiazide Benicar Multaq Benicar HCT nadolol betaxolol nadolol-bendroflumethiazide bisoprolol fumarate Naturetin-5 bisoprolol-hydrochlorothiazide nicardipine hcl bumetanide nifedipine Bystolic nisoldipine candesartan-hydrochlorothiazide nitroglycerin candesartan perindopril captopril pindolol captopril-hydrochlorothiazide prazosin hcl Cardura XL procainamide carvedilol propafenone hcl Catapres-TTS propranolol hcl chlorothiazide propranolol hcl w/hctz chlorthalidone propranolol-hydrochlorothiazide clonidine hcl quinapril clonidine-chlorthalidone quinapril-hydrochlorothiazide Coreg CR digoxin ramipril diltiazem hcl Ranexa Diovan reserpine Diovan HCT Rythmol SR disopyramide Saluron disopyramide cr sotalol doxazosin spironolactone Dutoprol spironolactone/hctz Edarbyclor Tarka Edarbi Tekamlo Edecrin Tekturna enalapril maleate Tekturna HCT enalapril-hydrochlorothiazide terazosin hcl eplerenone Teveten HCT eprosartan Tikosyn Exforge timolol maleate Exforge HCT torsemide felodipine ER trandolapril flecainide acetate triamterene fosinopril sodium triamterene-hctz fosinopril-hydrochlorothiazide Tribenzor furosemide Twynsta guanabenz acetate Valturna guanfacine hcl verapamil hydralazine hcl hydrochlorothiazide Cholesterol Lowering Advicor indapamide Altoprev Innopran XL amlodipine-atorvastatin irbesartan Antara irbesartan-hydrochlorothiazide atorvastatin isosorbide dinitrate cholestyramine isradipine colestipol labetalol hcl Crestor Levatol fenofibrate lisinopril Fenoglide lisinopril-hydrochlorothiazide Fibricor losartan potassium fluvastatin losartan-hydrochlorothiazide Marpres gemfibrozil 3 Drug Name (generic name products are Drug Name (generic name products are Drug Class generally lowercase) Drug Class generally lowercase) Cholesterol Lowering Juvisync Diabetes Januvia (Continued) Lescol XL (Continued) Jentadueto Lipofen Juvisync Livalo Kazano lovastatin Kombigylze Lovaza Lantus Niacor Levemir Niaspan metformin pravastatin nateglinide Simcor Nesina simvastatin Novolin Triglide Novolog Trilipix Onglyza Vascepa Oseni Vytorin Prandimet Welchol Prandin Zetia Symlin tolazamide Depression hcl tolbutamide amitriptyline-chlordiazepoxide Tradjenta Victoza Aplenzin bupropion hcl Eye Conditions sulfate citalopram Azopt hcl betaxolol hcl Cymbalta betimol brimonidine tartrate hcl carteolol hcl escitalopram Combigan fluoxetine Cosopt fluvoxamine Cyclogyl cyclomydril hcl dorzolamide dorzolamide/timolol nefazodone hcl Epinal hcl Oleptro ER Humorsol isopto perphenazine-amitriptyline isopto hyoscine Pexeva latanoprost Pristiq levobunolol hcl hcl Lumigan sertraline Mydriacyl Surmontil optipranolol trazodone hcl Paremyd venlafaxine phospholine iodide Viibryd Diabetes acarbose propine Actoplus Met Restasis Actos timolol Apidra Travatan Avandamet Avandaryl Trusopt Avandia Bydureon Byetta Heartburn/Ulcer Aciphex chlorpropamide cimetidine Cycloset Dexilant Duetact famotidine glimepiride lansoprazole glipizide misoprostol glipizide-metformin Nexium glyburide omeprazole Glyburide-Metformin hcl omeprazole-sod bicarb Glyset pantoprazole sodium Humalog ranitidine Humulin sucralfate Janumet 4 Drug Name (generic name products are Drug Name (generic name products are Drug Class generally lowercase) Drug Class generally lowercase) Hormone Replacement Activella Miscellaneous methazolamide cabergoline (Continued) methimazole Cenestin Pancreaze Combipatch Pancrelipase EC Depo-Provera Pentasa Divigel potassium chloride Elestrin probenecid Enjuvia propylthiouracil estradiol pyridostigmine bromide estradiol patch Renagel Estrasorb Renvela Estring Uloric Estrogel Ultrase estrogen & methyltestosterone Ultresa Estrace ursodiol estropipate Viokase Femhrt Zenpep Femring Femtrace Osteoporosis Actonel levothyroxine alendronate liothyronine sodium etidronate disodium medroxyprogesterone Evista Menest Fosamax Plus D Menostar ibandronate Mimvey Miacalcin norethindrone acetate Skelid Ogen Prefest Premarin Pain & Anaprox Premphase Celebrex Prempro Inflammatory Disease diclofenac sodium progesterone diflunisal Thyroid diclofenac-misoprostol Thyrolar Duexis Tirosint etodolac Vagifem fenoprofen calcium Vivelle-Dot Flector Infections acyclovir flurbiprofen azulfidine ibuprofen ethambutol hcl ketoprofen famciclovir leflunomide isoniazid meclofenamate sodium Paser meloxicam pyrazinamide nabumetone Relenza naproxen Tamiflu oxaprozin valacyclovir piroxicam Valcyte Pennsaid Savella Miscellaneous acetazolamide sulindac allopurinol tolmetin sodium aminobenzoate potassium Vimovo Apriso Voltaren Gel Asacol belladona-phenobarbital calcitriol Parkinson’s Disease amantadine calcium acetate Azilect Colcrys benztropine mesylate Creon bromocriptine Dipentum carbidopa/levodopa Eliphos carbidopa-levodopa-entacapone Enulose entacapone Equetro Horizant Evoxac Fosrenol ropinirole Giazo selegiline hcl sulfate Tasmar Lialda hcl lithium 5 Drug Name (generic name products are Drug Name (generic name products are Drug Class generally lowercase) Drug Class generally lowercase) Prostate alfuzosin Skin Conditions fludrocortisone acetate Avodart hydrocortisone doxazosin finasteride Jalyn Rapaflo tamsulosin hcl terazosin

Seizure Banzel carbamazepine Carbatrol Celontin clonazepam Depakene Depakote ethosuximide Felbatol gabapentin Gabitril Keppra XR lamotrigine levetiracetam Lyrica mephobarbital oxcarbazepine Oxtellar XR phenytoin Potiga primidone Stavzor Tegretol XR topiramate Vimpat zonisamide Please note: This list is subject to change.

“Cigna,” the “Tree of Life“ logo and “GO YOU” are registered service marks, and “Cigna Home Delivery Pharmacy” is a service mark, 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, including Connecticut General Life Insurance Company and Cigna Health and Life Insurance Company, and not by Cigna Corporation. 834176 c 05/13 © 2013 Cigna. Some content provided under license.