Cigna Changes in Drug Formulary Effective January 1
December 2018 ~
Cigna will be updating its drug formulary effective January 1. This update will focus on specific categories, including ADHD, anticonvulsants, topical antivirals, and PPIs, TIRF.
CHANGES IN DRUG FORMULARY EFFECTIVE JANUARY 1, 2019
Cigna will update the following categories of its drug formulary effective in the New Near:
› Attention Deficit Hyperactivity Disorder (ADHD) – Cigna will remove certain drugs from its formularies, and expand utilization management programs to help reduce inappropriate use of high-cost dose forms and promote coverage of generic use. Additionally, the insurer will apply age limits on individuals 13 years of age or older on certain branded drugs to reduce inappropriate utilization of orally disintegrating tablets and liquids.
› Anticonvulsants – Cigna will prefer coverage of generic options for customers who are using anticonvulsants for non-seizure disorders (such as for the prevention of headaches). Specifically: – Cigna will not cover certain branded drugs in its formularies that have alternatives containing similar or near-similar ingredients. – For brand-name drugs with no alternatives or limited alternatives, the insurer will require prior authorization for coverage. Minors under 18 years of age will not be affected. – By using combined medical and pharmacy claims data, when available, Cigna will identify customers with a documented seizure disorder, as well as those under 18 years of age, to ensure they do not need to obtain a prior authorization for coverage of a brand-name anticonvulsant drug.
› Topical Acne – Cigna will not cover all brand-name drugs in its formularies due to availability of multiple over-the-counter or generic alternatives.
› Cholesterol (PCSK9) – Cigna will move the injectable drug Repatha® to preferred brand status, subject to prior authorization. Cigna will not cover PRAULENT® in its formularies.
› Topical Antivirals – Research has shown that topical antiviral therapy provides little clinical value in the treatment of herpes, when compared to oral drug treatment. Oral antiviral regimens are the most clinically effective ways to shorten the length of symptoms and stop the recurrence of infection. Cigna will not cover topical antiviral creams for herpes in its formularies. If approved through a coverage exception review, these drugs will be subject to quantity limits.
› Proton Pump Inhibitors (PPIs) – Cigna will add NEXIUM® Powder Packets to its formularies to provide an alternative option to swallowable tablets and capsules.
› Human Immunodeficiency Virus And Acquired Immune Deficiency Syndrome (HIV/AIDS) – Cigna will offer preferred tier placement for clinically effective combination regimens, which combine several active ingredients into one or more pills. Depending on the customer’s treatment plan, this may reduce the amount he or she must pay under the plan for combination regimens.
› Inflammatory – Cigna are adding ENTYVIO®, which will provide an additional coverage option under the medical benefit for treatment of Crohn’s disease and ulcerative colitis. Like other drugs in this class, ENTYVIO will be subject to prior authorization, but will be in a preferred position for the treatment of Crohn’s disease and ulcerative colitis.
› Transmucosal Immediate Release Fentanyl (TIRF) – To ensure appropriate patient access to opioids, Cigna will require prior authorization for the following TIRF drugs when prescribed for non-cancer related treatment: – Abstral® – ACTIQ® and generic ACTIQ alternatives – FENTORA® – Lazanda® – SUBSYS®
For more information and a list of the affected drugs, or to search for alternative medications for patients, refer to Cigna’s 2019 Prescription Drug List Changes and Pharmacy (Drugs & Biologics) A-Z Index.
Source(s): Cigna Network News October 2018;