Cigna Healthcare U.S. Pharmacy Formulary Changes

As part of our ongoing commitment to affordable, high quality healthcare, Cigna Healthcare regularly reviews and updates its U.S. pharmacy formulary. These reviews typically take place twice a year and are designed to balance access, quality, and cost effectiveness for customers.

Formulary updates may include:

• Removal of medications with disproportionately high cost and limited clinical value
• Encouraging the use of clinically equivalent generic alternatives
• Positive changes that enhance access to safe, effective medications

Our low net drug cost and utilisation management (UM) strategy plays an important role in maintaining affordability for customers, while continuing to support appropriate clinical care.

Customer and broker communications

For customers impacted by a formulary change, Cigna Healthcare will provide advance notification approximately 45 days prior to the change taking effect. We will also notify you, the broker, of affected customers, allowing sufficient time for customers to speak with their doctor and, where needed, explore suitable alternative treatment options to support continuity of care.

Understanding the three tier drug list

Global Individual Health (GIH) plans use a three tier U.S. prescription drug list:

• Tier 1 – Generic medications
  Generic drugs have the same active ingredients and strength as brand name medications and typically cost significantly less.
• Tier 2 – Preferred brand medications
  These are brand name drugs that may cost more than generics but less than non preferred brands.
• Tier 3 – Non preferred brand medications
  These generally have higher costs and may have clinically appropriate lower cost alternatives.

Where to find the drug list

Brokers and customers can view the most up to date U.S. drug list at cigna.com/druglist. When prompted, select “Performance 3 Tier” from the dropdown menu.

Back to homepage