Prescription drug
Your medication costs vary based on your medical plan and whether you use generic, preferred brand, non-preferred brand or specialty drugs and whether you fill your prescriptions with an in-network or out-of-network pharmacy. Using generic and preferred brands will ensure the best rates for your prescription needs.
If you enroll in medical coverage, you are automatically enrolled in prescription drug coverage.
Cigna prescription drug benefit
| Plan features | Cigna HRA | Cigna HSA | Cigna PPO | |||
|---|---|---|---|---|---|---|
| In-network | Out-of-network | In-network | Out-of-network | In-network | Out-of-network | |
| 30-day supply through retail or mail order | ||||||
| Preventive* | No copay | 50% after deductible | 0%, no deductible | 50% after deductible | No copay | 50% |
| Generic | $15 copay | 50% after deductible | 25% after deductible | 50% after deductible | $15 copay | 50% |
| Preferred brand | 30% up to $125 max | 50% after deductible | 30% after deductible (up to $125 max) |
50% after deductible | $30 copay | 50% |
| Non-preferred brand | 40% up to $225 max | 50% after deductible | 40% after deductible (up to $225 max) |
50% after deductible | $60 copay | 50% |
| Specialty (limited to a 30-day supply) |
40% up to $225 max | 50% after deductible | 40% after deductible (up to $225 max) |
50% after deductible | $80 copay | 50% |
| 90-day supply through retail or mail order (Note: Mail order is not covered out-of-network.)** | ||||||
| Preventive | No copay | 50% after deductible | 0%, no deductible | 50% after deductible | No copay | 50% |
| Generic | $37 copay | 50% after deductible | 25% after deductible | 50% after deductible | $37 copay | 50% |
| Preferred brand | 30% up to $312 max | 50% after deductible | 30% after deductible (up to $312 max) | 50% after deductible | $75 copay | 50% |
| Non-preferred brand | 40% up to $562 max | 50% after deductible | 40% after deductible (up to $562 max) | 50% after deductible | $150 copay | 50% |
You can obtain specific preventive medications in-network with reduced cost-share as follows:
- There is no cost for medications on Cigna’s No Cost-Share Preventive Medication (ACA) list for all plan participants.
- Additionally, for Cigna HSA Plan participants, when you purchase other preventive medications listed on Cigna’s 2023 Preventive Generics and Preferred Brands Drug list, you will pay 20% coinsurance, but no deductible applies.
- To see Cigna’s lists of preventive medications, visit mycigna.com. For cost details regarding preventive medications and the National Preferred Formulary, contact Cigna at 1-888-806-5042.
** You must fill maintenance medication prescriptions in a 90-day supply through Cigna 90 Now.
Kaiser Permanente Prescription drug benefits (for California residents)
| Plan features | Kaiser HRA | Kaiser HSA | Kaiser HMO |
|---|---|---|---|
| Retail Generic (up to a 30-day supply) |
$10 copay | $10 copay after deductible | $10 copay |
| Retail Brand Formulary (up to a 30-day supply) |
$30 copay | $30 copay after deductible | $30 copay |
| Mail Generic (up to a 100-day supply) |
$20 copay | $20 copay after deductible | $20 copay |
| Mail Brand Formulary (up to a 100-day supply) |
$60 copay | $60 copay after deductible | $60 copay |
| Specialty (up to a 30-day supply) |
20% coinsurance (not to exceed $150) |
20% coinsurance after deductible (not to exceed $250) |
20% coinsurance (not to exceed $250) |
*Under the HSA Plan, if more than one individual is enrolled, an individual deductible must be met per family member. Once this, or the family deductible has been met, the plan will pay each enrolled family member’s covered expenses based on the co-insurance level. However, one individual may satisfy the per person out-of-pocket maximum.
Generics
Generic drugs usually cost less than brand name drugs.
Generic drugs are reviewed by the FDA to ensure that they work the same as the brand-name drug in dosage, safety, quality, performance, strength and usage.
To help keep prescription drug costs in check, prescriptions are automatically filled with a chemically equivalent generic drug, if available and appropriate. If you choose a brand drug when a generic is available, you will pay the difference between the brand medication and the generic, plus the coinsurance. However, if your doctor indicates “Dispense as Written” on your prescription because the brand is medically necessary, you will receive the brand drug and only pay the brand copay.
Note: If you choose a brand drug when a generic is available, you will pay the difference between the brand medication and the generic, plus the coinsurance.
Preferred brand drugs
Brand-name drugs on the preferred list are less expensive than using a non-preferred drug.
Non-preferred brand drugs
Brand-name drugs that are not on your preferred list may cost you more, even if they are recommended by your doctor.
Maintenance medications
Long-term medications, also known as maintenance drugs, are taken on a regular basis (three months or longer) to treat conditions such as high cholesterol, high blood pressure and asthma.
Cigna participants: Maintenance medications are filled through Cigna 90 Now.
Specialty drugs
A specialty drug is a medication used to treat chronic, complex conditions like multiple sclerosis, hepatitis C and cancer. Specialty medications can include oral solids, or can be injected, infused or inhaled and may require special handling, such as refrigeration.
Cigna participants: use Accredo Specialty Pharmacy for specialty drugs.
Preventive medications
Certain preventive medications and supplies are covered at no cost to you and are not subject to meeting a deductible. These medications require a prescription and are subject to certain eligibility requirements. Check with your medical plan provider for details.