Specialty medications are used to treat complex conditions like multiple sclerosis, hepatitis C and rheumatoid arthritis. This drug list includes the most commonly prescribed specialty medications covered by your plan as of January 1, 2018.+
Depending on your plan, medications marked with an asterisk (*) may be covered under your pharmacy Cigna Specialty Pharmacy Services can benefit, medical benefit, or covered under both benefits. help you manage your health and If you’re filling one of these medications at a retail prescription needs pharmacy, you’ll have to switch to Cigna Specialty Pharmacy Services for it to be covered. If the We want to make sure you’re receiving the care medication is covered under your medical benefit and and support you need every step of the way. Our you’re getting it from your health care provider, you’re therapy management teams, made up of health not required to use home delivery. advocates with nursing backgrounds and pharmacists, are specially trained to deliver the This drug list is not a complete list of covered specialty best experience possible by offering: medications, and not all of the medications listed here may be covered by your specific plan. This list is also › 24/7 access to customer service and regularly updated. You should log into myCigna.com or pharmacists to help you with any questions check your plan materials to learn more about the › Convenient delivery right to your door, or specialty medications your plan covers. location of your choice, in packaging designed to protect your privacy › Helpful coaching and reminder services › Supplies like tape, bandages, sharps collector, swabs, etc. – at no additional charge › Educational materials › Financial assistance programs if you need help paying for your medications It’s easy to get started using Cigna Specialty Pharmacy Services. Call us at 800.351.3606 or go to cigna.com/specialty-pharmacy-services.
Offered by: Cigna Health and Life Insurance Company or Connecticut General Life Insurance Company. 893271 c Specialty FACETS 08/17 Specialty medications Drug name
A Arcalyst Camptosar D abacavir^ argatroban capecitabine*^ dacarbazine abacavir-lamivudine^ Arixtra Caprelsa^ Dacogen abacavir-lamivudine- Arranon carboplatin Daklinza*^ zidovudine^ Arzerra Carimune NF* Darzalex* Abraxane Astagraf XL*^ Casodex*^ daunorubicin Actemra* Atgam Cayston Daunoxome Acthrel Atripla^ Cellcept*^ DDAVP Actimmune* Aubagio*^ Ceprotin* decitabine Adagen Austedo^ Cerdelga*^ Defitelio* Adcetris Avastin Cerezyme* Depen*^ Adcirca*^ Avonex* cetrotide Depocyt adefovir dipivoxil*^ azacitidine Cholbam^ Descovy^ Adempas^ Azasan*^ chorionic gonadotropin desmopressin Adriamycin azathioprine*^ cidofovir didanosine^ Cimzia* Adrucil B Docefrez* Advate* Cinqair docetaxel* Baraclude*^ Adynovate* Cinryze Doxil Bavencio Afinitor Disperz*^ cisplatin doxorubicin BCG Vaccine (Tice Strain) Afinitor*^ cladribine Duopa Bebulin* Afstyla* clofarabine Dupixent* Beleodaq Agrylin*^ Clolar Dysport* Bendeka* Akynzeo^ Coagadex BeneFIX* E Aldurazyme* Combivir^ Benlysta Alecensa*^ Cometriq^ Edurant^ Berinert Alferon N* Complera^ Egrifta* Betaseron* Alimta Copaxone* Elaprase Bethkis* Alkeran Copegus*^ Elelyso bexarotene*^ Aloxi Corifact Eligard* Bexxar Alphanate* Cosentyx* Elitek bicalutamide*^ Alphanine SD* Cosmegen Ellence BiCNU Alprolix* Cotellic*^ Eloctate* Bivigam* Alunbrig^ Crixivan^ Eloxatin Bleo 15K Amicar*^ Cuprimine*^ Elspar bleomycin amifostine Cuvitru Emcyt*^ Blincyto aminocaproic acid*^ cyclophosphamide*^ Emend^ Boniva* Ampyra*^ cyclosporine*^ Emflaza^ Bosulif*^ Amvisc Cyklokapron Empliciti* Botox* Amvisc Plus Cyramza Emtriva^ Bravelle anagrelide*^ Cystadane^ Enbrel* Brineura Anzemet^ Cystagon^ enoxaparin busulfan Apokyn* cytarabine entecavir*^ Busulfex aprepitant^ Cytogam Entyvio* Aptivus^ C Cytovene Envarsus XR*^ Epclusa^ Aralast NP Cabometyx^ epirubicin Aranesp Campath Epivir HBV^
2 Specialty medications Drug name
Epivir^ Gattex I Kaletra^ Epogen Gazyva ibandronate* Kalydeco^ epoprostenol Gel-One* Ibrance*^ Kanuma Epzicom^ Gelsyn-3* Iclusig^ Kepivance Erbitux gemcitabine Idamycin PFS Kevzara* Erivedge*^ Gemzar idarubicin Keytruda Erwinaze Gengraf*^ Idelvion* Kineret Esbriet*^ Genotropin* Ifex Kisqali Femara Co-Pack*^ Ethyol Genvisc 850* ifosfamide Kisqali*^ Etopophos Genvoya^ Ifosfamide-Mesna Kitabis Pak etoposide*^ Gilenya*^ Ilaris* Koate* Evotaz^ Gilotrif^ Iluvien Koate-DVI* Exjade*^ Glassia imatinib*^ Kogenate FS* Exondys 51 Glatopa* Imbruvica^ Kovaltry* Extavia* Gleevec*^ Imfinzi Krystexxa Eylea Gliadel Imlygic Kuvan*^ Gonal-F Kyleena* F Imogam Rabies-HT Gonal-F RFF Imuran*^ Kynamro Fabrazyme* Gonal-F RFF Redi-Ject Incivek*^ Kyprolis* Farydak^ Granix Increlex Faslodex L Infergen* Feiba NF* H lamivudine HBV^ Inflectra* Firazyr* H.P. Acthar* lamivudine^ Ingrezza^ Firmagon Haegarda lamivudine-zidovudine^ Inlyta*^ Flebogamma DIF Halaven Lartruvo Intelence^ Flolan Harvoni*^ Lemtrada* Intron A* floxuridine Hecoria*^ Lenvima^ Invirase^ fludarabine Helixate FS* Letairis*^ Iprivask* fluorouracil Hemofil M* leucovorin*^ Iressa^ flutamide*^ Hepagam B Leukine irinotecan Follistim AQ Hepsera*^ leuprolide* Isentress HD^ Folotyn Herceptin levoleucovorin Isentress^ fondaparinux Hexalen*^ Lexiva^ Istodax Forteo* Hizentra* Liletta Ixempra Fragmin Humate-P* Lipodox Ixinity* Fusilev Humatrope* Lonsurf^ Fuzeon Humira* J lopinavir-ritonavir^ Hyalgan* Lovenox G Jadenu Sprinkle*^ Hycamtin*^ Jadenu*^ Lucentis Gamastan S-D* Hylenex* Jakafi^ Lumizyme Gammagard Liquid* Hymovis Jetrea Lupaneta Pack* Gammagard S-D* Hyperhep B S-D Jevtana* Lupron Depot* Gammaked* Hyperrab S-D Juxtapid^ Lupron Depot-Ped* Gammaplex Hyperrho S-D Lynparza^ Gamunex-C* K Hyqvia Lysteda^ ganciclovir Kadcyla ganirelix Kalbitor
3 Specialty medications Drug name
M Northera^ Perjeta Riastap Maci Norvir^ Photofrin Ribasphere Ribapak*^ Macugen Novarel Plegridy* Ribasphere*^ Marqibo Novoeight* Pomalyst*^ Ribatab*^ Matulane^ Novoseven RT* Portrazza ribavirin*^ Mekinist*^ Nplate Praluent* Rilutek*^ melphalan^ Nucala* Praxbind riluzole*^ Menopur Nulojix Pregnyl Rituxan mesna Nuplazid^ Prezcobix^ Rituxan Hycela Mesnex^ Nutropin AQ* Prezista^ Rixubis* methotrexate*^ Nuwiq Prialt Rubraca^ Privigen* Ruconest MICRhoGAM Ultra- O Filtered Plus Procrit Rydapt*^ Obizur Mircera Procysbi^ Ocaliva^ S Mirena Profilnine* Ocrevus* Sabril^ mitomycin Prograf*^ Octagam* Saizen* mitoxantrone Prolastin C octreotide* Saizen-Saizenprep* Moderiba*^ Proleukin Odefsey^ Samsca*^ Monoclate-P* Prolia Odomzo*^ Sandimmune*^ Mononine* Promacta*^ Ofev^ Sandostatin LAR Depot Monovisc* Provenge Olysio*^ Sandostatin LAR* Mozobil Provisc Omnitrope* Sandostatin* Mustargen Pulmozyme* Oncaspar Selzentry^ Myalept Purixan^ Onivyde Sensipar^ mycophenolate*^ Opdivo R Serostim* mycophenolic acid*^ Opsumit*^ Radicava* Signifor Myfortic*^ Orencia Clickject* Rapamune*^ Signifor LAR Myobloc Orencia* Rasuvo sildenafil*^ Myozyme Orenitram ER^ Rebetol*^ Siliq* N Orfadin^ Rebif Rebidose* Simponi Aria* Nabi-HB Orkambi^ Rebif* Simponi* Naglazyme Orthovisc* Reclast* Simulect Natpara Otezla*^ Recombinate* sirolimus*^ Natrecor Otrexup* Remicade* Skyla Navelbine Ovidrel Remodulin Soliris Neoral*^ oxaliplatin Repatha* Somatuline Depot Repronex Somavert Neulasta* P Neumega Rescriptor^ Sovaldi*^ paclitaxel Neupogen Retrovir^ Spinraza pamidronate* nevirapine ER^ Revatio*^ Sprycel*^ Panhematin nevirapine^ Revlimid*^ stavudine^ Panretin* Nexavar*^ Reyataz^ Stelara* paricalcitol (vial) Nexavir Rheumatrex^ Stimate paricalcitol*^ (capsule) Ninlaro^ RhoGam Ultra-Filtered Stivarga*^ Pegasys* Nipent Plus Strensiq Pegintron* Norditropin* Rhophylac Stribild^
4 Specialty medications Drug name
Sucraid^ Tobi Podhaler* Viekira Pak*^ Y Supartz FX* Tobi* Viekira XR*^ Yervoy Supartz* tobramycin* Vimizim Yondelis* Supprelin LA* Toposar vinblastine Z Sustiva^ topotecan* Vincasar PFS Sutent*^ Torisel vincristine Zaltrap Sylatron* Tracleer*^ vinorelbine Zanosar Sylvant tranexamic acid^ Viracept^ Zarxio Synagis* Treanda Viramune XR^ Zavesca^ Synarel* Trelstar* Viramune^ Zejula^ Synribo Tretten Virazole* Zelboraf*^ Synvisc* Trexall*^ Viread^ Zemaira Synvisc-One* Trisenox Vistide Zemplar*^ Syprine*^ Triumeq^ Vistogard^ Zepatier*^ Trizivir^ Visudyne Zerit^ T Truvada^ Vitekta^ Zevalin tacrolimus*^ Tybost^ Vivitrol* Ziagen^ Tafinlar*^ Tykerb*^ Vonvendi zidovudine^ Tagrisso^ Tymlos* Voraxaze Zinbryta Taltz* Tysabri* Votrient*^ Zinplava Tarceva*^ Tyvaso VPRIV* Zoladex* Targretin*^ Tyzeka*^ zoledronic acid* Tasigna*^ W Zolinza^ Taxotere* U Wilate* Zomacton* Tecentriq* Unituxin WinRho SDF* Zometa* Tecfidera*^ Uptravi^ X Zorbtive Technivie*^ Zortress*^ V Xalkori*^ Temodar (vial) Zydelig^ Valchlor Xeljanz XR*^ Temodar*^ (capsule) Zykadia*^ Valstar Xeljanz*^ temozolomide*^ Zytiga*^ Vantas* Xeloda*^ teniposide Varubi^ Xenazine^ Tepadina Vectibix Xeomin* tetrabenazine^ Velcade Xermelo^ Tev-Tropin* Veletri Xgeva Thalomid*^ Vemlidy^ Xiaflex* Theracys Venclexta^ Xolair* Thiotepa Ventavis Xtandi*^ Thrombate III Victrelis*^ Xuriden^ Thymoglobulin Vidaza Xyntha* Thyrogen Videx^ Xyrem^ Tivicay^ Videx EC^
* If your plan requires you to use home delivery for specialty medications and the specialty medication marked with an asterisk (*) is covered under your pharmacy benefit, you have to fill this medication through Cigna Specialty Pharmacy Services for it to be covered. Depending on your plan, you may be able to fill your prescription one time at any in-network retail pharmacy before you have to use Cigna Specialty Pharmacy Services. ^ This Oral specialty medication may be covered differently than other specialty medications. Refer to your plan materials ormyCigna.com for coverage information.
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Cigna reserves the right to make changes to the Drug List without notice. Your plan may cover additional medications; please refer to your enrollment materials for details. Cigna does not take responsibility for any medication decisions made by the doctor or pharmacist. Cigna may receive payments from manufacturers of certain preferred brand medications, and in limited instances, certain non-preferred brand medications, that may or may not be shared with your plan depending on its arrangement with Cigna. Depending upon plan design, market conditions, the extent to which manufacturer payments are shared with your plan and other factors as of the date of service, the preferred brand medication may or may not represent the lowest-cost brand medication within its class for you and/or your plan.
+ State laws in Texas and Louisiana require your plan to cover your medications at your current benefit level until your plan renews. This means that if your medication is taken off the drug list, is moved to a higher cost-share tier or needs approval, your plan can’t make these changes until your renewal date. To find out if these state laws apply to your plan, please call Customer Service using the number on the back of your ID card.
Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. If your plan provides coverage for certain prescription drugs with no cost-share, you may be required to use an in-network pharmacy to fill the prescription. If you use a pharmacy that does not participate in your plan’s network, your prescription may not be covered, or reimbursement may be limited by your plan’s copayment, coinsurance or deductible requirements. Certain features described in this document may not be applicable to your specific health plan, and plan features may vary by location and plan type. Refer to your plan documents for costs and complete details of your plan’s prescription drug coverage. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., Tel-Drug, Inc., and Tel-Drug of Pennsylvania, L.L.C. “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. Policy forms: OK - HP-APP-1 et al (CHLIC); TN - HP-POL43/HC-CER1V1 et al (CHLIC). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 893271 c Specialty FACETS 08/17 © 2017 Cigna. Some content provided under license.