4 PA Prior Authorization* – This medication needs approval from Cigna Healthcare before your plan will cover it. Your doctor’s office will have to send us information to review to make sure you meet the medication's coverage rules (requirements). QL Quantity Limit* – Your plan will only cover so much of this medication at one time. If your doctor wants you to fill more than what’s allowed, your doctor’s office can ask us to cover more. ST Step Therapy* – This is a high-cost medication that has a lower-cost alternative(s) that treats the same condition. Your plan won’t cover this medication until you try at least one preferred medication first (typically a generic or preferred brand) and can show that it didn’t work for you. If your doctor feels a preferred medication isn’t right for you, your doctor’s office can ask us to cover the higher-cost medication. AGE Age Requirement* – Your plan will only cover this medication if you’re a certain age or within a certain age range. If you’re not within the allowed age range and your doctor wants you to use the medication, your doctor’s office can ask us to cover it. SP This is a specialty medication, which is used to treat a rare and/or complex medical condition. Some plans have extra coverage rules (requirements) for specialty medications. For example, some may only cover up to a 30-day supply and/or require you to fill it at a preferred specialty pharmacy to be covered. Brand-name medications are in all capital letters In this drug list, generic medications are listed in all lowercase letters and brand-name medications are listed in all CAPITAL letters. Tiers We put covered medications into tiers (or cost-share levels). Typically, the higher the tier, the higher the price you’ll pay for the medication. * Not all plans have extra coverage rules (requirements) on medications. Log in to the myCigna App or myCigna.com, or check your plan materials, to see if yours does. Letters (acronyms) in the Notes column In this drug list, some medications have letters (acronyms) next to them in the Notes column. Here’s what they mean. Tier 1 Generics. These medications are covered at your plan’s lowest cost-share. Generics work in the same way and provide the same clinical benefits as their brand-name versions – and typically cost much less.3 $ Tier 2 Preferred Brands. These medications typically have one or more lower-cost generic that treats the same condition. $$ Tier 3 Non-Preferred Brands. These medications are covered at your plan’s highest cost-share. Non-preferred brands typically have a generic and/or preferred brand alternative(s) that treats the same condition. $$$ Tier 4 Specialty. These medications are covered at your plan’s highest cost-share. This tier includes both injectable and oral (those you take by mouth) specialty medications. $$$$