FORMULARY

NON FORMULARY - NOT COVERED DRUGS

TYPES OF FORMULARIES

• OPEN > INCLUDES ALL MEDICARE COVERED PART D DRUGS
• CLOSED > ONLY SELECTED DRUGS FROM THE MEDICARE PART D LIST

TYPES OF FORMULARIES All the Cigna Medicare Plans have closed formularies. There are separate formularies for each plan. We will generally cover all drugs on our drug list as long as: · The drug is medically necessary (e.g., a drug prescribed for "lifestyle" purposes is not medically necessary), · The prescription is filled at a network pharmacy and; · Other coverage rules are followed.

DRUG CATEGORIES Brand-name Drugs - Trademarked medications made and sold by Athe original manufacturer, sometimes co- licensed to others. Generic Drugs - Lower-cost versions with the same active ingredients, approved by the FDA to be just as safe and effective, but may have different inactive ingredients.

EXCLUDED PART D DRUGS

• OTC DRUGS
• FERTILITY DRUGS
• DRUGS FOR WEIGHT/ GAIN DRUGS
• COSMETIC OR HAIR GROWTH DRUGS
• COUGH AND COLD RELIEF
• PRECRIPTION VITAMINS/ MINERALS
• ERECTILE DUYSFUNCTION DRUG
• DRUGS REQUIRING MANUFACTURER - ONLY TESTING

PART B COVERED DRUGS INCLUDES:

• OFFICE ADMINISTERED DRUGS
• INFUSED MEDICATIONS
• DRUGS GIVEN VIA DME
• SOME ORAL MEDICATIONS

CSP (EXPRESS SCRIPTS) NAVIGATION

BENEFITS > DRUG COVERAGE > SEARCH PRESCRIPTION > ASK IN WHAT FORM OF DRUG > PHARMACY LOOK UP > VERIFY THE ZIP CODE OF THE MEMBER > UPON SEARCHING - THOSE WHO WERE ON AN ORANGE CHECK IS COVERED DRUG BY PDP > SELECT PHARMACY >

MEMBER CAN FILE NON-FORMULARY EXCEPTION

1. MILLIPRED ORAL SOLUTION
2. RAPAFLO
3. OSCIMIN TABLET/ODT/SR/ER/ (FOR PEPTIC ULCER)
4. CLEOCIN T
5. CORGARD
6. JUBLIA
7. VALIUM
8. VOSPIRE ER
9. OXYCODONE ORAL SOLUTION/CONCENTRATE

You also need to consult doctors for this alternates medication to check if these medicines are good for you.

CLOSING SPIEL