CIGNA HOME DELIVERY PHARMACY DRUG LIST
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1 CIGNA HOME DELIVERY PHARMACY DRUG LIST For customers who must use home delivery for maintenance medications Under your prescription drug plan, you have to fill prescriptions for maintenance medications (those taken on a regular basis) through Cigna Home Delivery Pharmacy. Depending on your benefit plan, you re typically allowed up to three fills at an in-network retail pharmacy before you have to use Cigna Home Delivery Pharmacy. At that time, if you haven t switched to Cigna Home Delivery Pharmacy, your plan will not cover the cost of your medication. In addition to cost savings, Cigna Home Delivery Pharmacy offers valuable benefits, such as: Licensed pharmacists available 24/7/365 Up to a 90-day supply of medications in one fill Free standard, on-time delivery to your home or location of your choice Reminders if you forget to fill your prescriptions Specialty medications, including those that require refrigeration and overnight delivery Visit mycigna.com or the mycigna Mobile App* and use the Prescription Drug Price Quote tool to search for medications, view costs based on your plan and see 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**. If you have questions Just call us using the toll-free number on the back of your ID card. We re here to help. This list of medications must be filled at Cigna Home Delivery Pharmacy. Please note: This list is subject to change, and may not exactly match what is covered on your specific pharmacy plan. Please check your enrollment materials for more information on the medications covered under your plan and to see if there are any additional requirements such as prior authorization (PA), quantity limits (QL) or Step Therapy (ST) f Exc 09/ Cigna
2 ADD/ADHD Strattera Asthma (Continued) ipratropium bromide Allergy Astepro ipratropium-albuterol azelastine levalbuterol hcl Beconase AQ montelukast cyproheptadine hcl Perforomist desloratadine Pulmicort Dymista Qvar flunisolide Serevent Diskus fluticasone propionate Spiriva ipratropium bromide (nasal) Symbicort Nasonex Tudorza Pressair Omnaris terbutaline sulfate Patanase theophylline Rhinocort Aqua zafirlukast triamcinolone acetonide (nasal) Zyflo Veramyst Birth Control Alyacen Alzheimer s Disease QNASL Xyzal Zetonna donepezil * Please check your enrollment materials to determine whether these medications are covered under your specific plan. Amethia Lo Angeliq Aranelle Ashlyna Exelon BeYaz galantamine hydrobromide Brevicon memantine Briellyn Namenda Cyclessa Namzaric Desogen pyridostigmine drosperinone-ethinyl estradiol rivastigmine (caps) Estrostep FE Asthma Advair Femcon FE albuterol Generess FE Alvesco Heather Arcapta Kariva Asmanex Kelnor Atrovent HFA Lessina Brovana levonorgest-ethinyl estradiol budesonide (neb soln) Loestrin Combivent Loryna cromolyn sodium Loseasonique Dulera Low-Ogestrel Flovent Marlissa Foradil Microgestin 2
3 Birth Control (Continued) Micronor Blood Thinner/Anti-Clotting Aggrenox Modicon aspirin-dipyridamole er Natazia cilostazol Necon clopidogrel norethindrone dipyridamole norethinindrone-ethinyl estradiol Effient norgestimate-ethinyl estradiol Eliquis Ogestrel pentoxifylline Ortho-Cept Pradaxa Ortho-Cyclen warfarin Ortho-Novum Xarelto Ortho TriCyclen Cancer anastrozole Ortho TriCyclen Lo exemestane Ovcon Fareston Quasense Faslodex Reclipsen letrozole Seasonique tamoxifen citrate Tilia Cardiovascular acebutolol Trivora amiloride Velivet amiloride-hydrochlorothiazide Xulane amiodarone Yasmin amlodipine besylate Yaz amlodipine-benazepril Zenchent FE amlodipine-valsartan Bladder Problems Zovia Ditropan XL Enablex flavoxate hcl Gelnique Transdermal Myrbetriq oxybutynin chloride Oxytrol Transdermal potassium citrate er Toviaz trospium chloride tolterodine Urocit-K Vesicare amlodipine-valsartanhydrochlorothiazide Amturnide atenolol atenolol-chlorthalidone Azor benazepril hcl benazepril-hydrochlorothiazide Benicar Benicar HCT betaxolol bisoprolol fumarate bisoprolol-hydrochlorothiazide bumetanide Bystolic 3
4 Cardiovascular (Continued) candesartan Cardiovascular (Continued) labetalol hcl candesartan-hydrochlorothiazide lisinopril captopril lisinopril-hydrochlorothiazide captopril-hydrochlorothiazide losartan potassium Cardura XL losartan-hydrochlorothiazide carvedilol methyclothiazide Catapres-TTS methyldopa chlorothiazide methyldopa-hydrochlorothiazide chlorthalidone metolazone clonidine hcl metoprolol clonidine-chlorthalidone metoprolol-hydrochlorothiazide Coreg CR mexiletine hcl Corlanor minoxidil digoxin moexipril diltiazem hcl moexipril-hydrochlorothiazide disopyramide Multaq doxazosin nadolol Dutoprol nadolol-bendroflumethiazide Edarbyclor nicardipine hcl Edarbi nifedipine Edecrin nisoldipine enalapril maleate nitroglycerin enalapril-hydrochlorothiazide perindopril Entresto pindolol eplerenone prazosin hcl eprosartan propafenone felodipine ER propranolol hcl flecainide acetate propranolol-hydrochlorothiazide fosinopril sodium quinapril fosinopril-hydrochlorothiazide quinapril-hydrochlorothiazide furosemide quinidine guanfacine hcl ramipril hydralazine hcl Ranexa hydrochlorothiazide reserpine indapamide sotalol Innopran XL spironolactone irbesartan irbesartan-hydrochlorothiazide isosorbide dinitrate isradipine spironolactonehydrochlorothiazide Tekturna Tekturna HCT telmisartan 4
5 Cardiovascular (Continued) telmisartan-amlodipine Depression amitriptyline hcl telmisartan-hydrochlorothiazide amitriptyline-chlordiazepoxide terazosin hcl amoxapine Tikosyn Aplenzin timolol maleate bupropion hcl torsemide Brintellix trandolapril citalopram trandolapril-verapamil clomipramine hcl triamterene desipramine triamterene-hydrochlorothiazide doxepin hcl Tribenzor duloxetine Twynsta escitalopram valsartan Fetzima valsartan-hydrochlorothiazide fluoxetine verapamil fluvoxamine Cholesterol Lowering Advicor imipramine Altoprev maprotiline hcl amlodipine-atorvastatin mirtazapine Antara nefazodone hcl atorvastatin nortriptyline hcl cholestyramine Oleptro ER colestipol paroxetine Crestor perphenazine-amitriptyline fenofibrate Pexeva fenofibric acid Pristiq Fenoglide protriptyline hcl fluvastatin sertraline gemfibrozil trazodone hcl Lescol XL trimipramine Livalo venlafaxine lovastatin Viibryd niacin er Diabetes acarbose Niacor Avandia omega-3 acid Bydureon pravastatin Byetta Simcor chlorpropamide simvastatin Cycloset Vascepa glimepiride Vytorin glipizide Welchol glipizide-metformin Zetia glyburide 5
6 Diabetes (Continued) glyburide-metformin hcl Eye Conditions (Continued) dorzolamide-timolol Glyset homatropine Humalog latanoprost Humulin levobunolol hcl Invokana Lumigan Janumet metipranolol Januvia Mydriacyl Jentadueto phospholine iodide Kazano pilocarpine Kombigylze Restasis Lantus Simbrinza Levemir timolol metformin Travatan Z nateglinide travoprost Nesina tropicamide Novolin Heartburn/Ulcer cimetidine Novolog Dexilant Onglyza esomeprazole magnesium Oseni famotidine pioglitazone lansoprazole pioglitazone-glimepiride misoprostol pioglitazone-metformin Nexium Prandimet omeprazole repaglinide omeprazole-sodium bicarbonate tolazamide pantoprazole sodium tolbutamide ranitidine Tradjenta rabeprazole Victoza sucralfate Eye Conditions atropine sulfate Hormone Replacement cabergoline Azopt Combipatch betaxolol hcl Depo-Provera Betimol Divigel brimonidine tartrate Elestrin carteolol hcl Enjuvia Combigan estradiol Cosopt estradiol patch Cyclogyl Estring Cyclomydril Estrogel dipivefrin estrogen & methyltestosterone dorzolamide Estrace 6
7 Hormone Replacement (Continued) estropipate Miscellaneous (Continued) Giazo Femhrt hyoscyamine sulfate Femring lactulose levothyroxine Lialda liothyronine sodium lithium Lopreeza methazolamide medroxyprogesterone methimazole Menest Osphena Menostar Pancreaze norethindrone acetate Pentasa norethindrone-ethinyl estradiol potassium chloride Prefest probenecid Premarin propylthiouracil Premphase pyridostigmine bromide Prempro Renagel progesterone Renvela Thyroid salsalate Tirosint Uloric Vagifem Ultresa Vivelle-Dot ursodiol Infections ethambutol hcl Viokace isoniazid Zenpep Paser Osteoporosis alendronate pyrazinamide Binosto sulfasalazine etidronate disodium Miscellaneous acetazolamide Fosamax Plus D allopurinol ibandronate Apriso Miacalcin Asacol HD raloxifene calcitriol risedronate calcium acetate Pain & Inflammatory Disease celecoxib colchicine diclofenac sodium Colcrys diclofenac potassium Creon diclofenac-misoprostol diflunisal diflunisal Dipentum etodolac Equetro fenoprofen calcium Evoxac Flector fludrocortisone acetate flurbiprofen Fosrenol ibuprofen 7
8 Pain & Inflammatory Disease (Continued) Parkinson s Disease ketoprofen leflunomide meclofenamate sodium meloxicam nabumetone naproxen oxaprozin piroxicam Pennsaid Savella sulindac tolmetin sodium Vimovo Voltaren Gel amantadine Azilect benztropine mesylate bromocriptine carbidopa-levodopa carbidopa-levodopa-entacapone entacapone Horizant pramipexole ropinirole selegiline hcl Tasmar trihexyphenidyl hcl Prostate Seizure alfuzosin Avodart doxazosin finasteride Jalyn Rapaflo tamsulosin hcl terazosin Banzel carbamazepine clonazepam divalproex ethosuximide felbamate gabapentin lamotrigine levetiracetam Lyrica oxcarbazepine Oxtellar XR phenytoin Potiga primidone tiagabine topiramate valproic acid Vimpat zonisamide Please note: This list is subject to change. * The downloading and use of the mycigna Mobile App is subject to the terms and conditions of the App and the online stores from which it is downloaded. Standard mobile phone carrier and data usage charges apply. **Prescription savings opportunities may not be available for some medications. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of Cigna Health Corporation. Cigna Home Delivery Pharmacy refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc f Exc 09/ Cigna. Some content provided under license.
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