01/01/2026 ASO Open Access Plus HDHPQ - HDHPQ 3500 Proclaim - 37302326 - V 33 - 10/20/25 05:17 PM ET 10 of 17 ©Cigna 2025 Pharmacy In-Network Cost Share and Supply Cigna Pharmacy Cost Share  Retail – up to 90-day supply (except Specialty up to 30-day supply)  Home Delivery – up to 90-day supply (except Specialty up to 30-day supply) Retail (per 30-day supply): Generic: You pay 20% ^ Preferred Brand: You pay 20% ^ Non-Preferred Brand: You pay 20% ^ Retail and Home Delivery (per 30-day supply): Specialty: You pay 20% ^ Retail and Home Delivery (per 90-day supply): Generic: You pay 20% ^ Preferred Brand: You pay 20% ^ Non-Preferred Brand: You pay 20% ^  Cigna 90 Now CVS: Retail drugs for a 30-day supply may be obtained in-network at a wide range of pharmacies across the nation although prescriptions for a 90-day supply (such as maintenance drugs) will be available at select network pharmacies. Walgreens will be considered out-of-network for a 90-day supply.  Cigna 90 Now Program: You can choose to fill your medications in a 30- or 90-day supply. If you choose to fill a 30-day prescription, it can be filled at any network retail pharmacy or network home delivery pharmacy. If you choose to fill a 90-day prescription, it must be filled at a 90-day network retail pharmacy or network home delivery pharmacy to be covered by the plan.  This plan will not cover out-of-network pharmacy benefits.  Specialty medications are used to treat an underlying disease which is considered to be rare and chronic including, but not limited to, multiple sclerosis, hepatitis C or rheumatoid arthritis. Specialty Drugs may include high cost medications as well as medications that may require special handling and close supervision when being administered.  When patient requests brand drug, patient pays the brand cost share plus the cost difference between the brand and generic drugs up to the cost of the brand drug (unless the physician indicates "Dispense As Written" DAW).  Exclusive specialty home delivery: Specialty medications must be filled through home delivery; otherwise you pay the entire cost of the prescription upon your first fill. Some exceptions may apply.  Your pharmacy benefits share an annual deductible and out-of-pocket maximum with the medical/behavioral benefits. The applicable cost share for covered drugs applies after the combined deductible has been met.  If you receive a supply of 34 days or less at home delivery, the home delivery pharmacy cost share will be adjusted to reflect a 30-day supply. Preventive Drugs: Federally required preventive drugs will not be subject to deductible and will be provided at no charge. In addition, In-Network Generic and Preferred Brand preventive drugs and products included in the Preventive Plus Package will not be subject to deductible and will be provided at no charge. This may apply to drugs for: Asthma, Cholesterol Lowering, Depression, Diabetes (including diabetic supplies and continuous glucose monitor supplies), Heart Disease and Stroke, High Blood Pressure, Osteoporosis, Smoking Cessation, Prenatal Vitamins, Prescription Vitamins