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Advantage PharmacyAdvantage Pharmacy lets you, physicians and pharmacists choose medications that work best for you. Fol owing is a list of commonly Advantage Pharmacy does not cover any drugs or drug categories used drugs covered by your plan. This list is not all inclusive. Please with over-the-counter equivalents or alternatives (e.g., proton pump refer to the Web site listed on your member ID card for access to inhibitors, non-sedating antihistamines, etc.), nor does it cover insulin information on all available drugs. When you use these preferred pens or cartridges, lifestyle medications (e.g., weight loss medications, drugs, you get the most out of your pharmacy benefit while keeping infertility drugs, erectile dysfunction agents, etc.) In addition, some plans may not cover some types of drugs such as contraceptives, even Your health plan covers prescription drugs at three levels. The amount you pay out-of-pocket depends on the tier from which you and your *Drugs marked with an asterisk are considered to be specialty drugs. physician select your medication. If your physician prescribes a more Some plans may cover specialty medications at different benefit expensive drug, it’s a good idea to ask him or her if a less expensive but equally effective drug is available. Since there may be more than one drug appropriate for your condition, we encourage you to Please refer to your Summary Plan Description for details on your use generic or preferred brand-name drugs when possible to help specific plan, including drugs that are covered or not covered, drugs that are covered at different benefit levels, drugs that require prior authorization, and quantity limits. You may be required to satisfy a deductible (separate from your health plan deductible) before your copay takes effect.
Lower cost; same quality and effectiveness as the brand-name drugTier 2: Preferred brand-name drugs More expensive than a generic; equal y effective as, but usual y less expensive This list is subject to change. Please use this drug list as a guide. If you have any questions, please call Member Services at the number Highest cost, which means your share of the cost will also be higher Tier 1: Common GeneriC DruGs
Tier 1: Common GeneriC DruGs
Tier 1: Common GeneriC DruGs
Tier 2: branD-name DruGs
Tier 2: branD-name DruGs
exClusions
The fol owing is a list of common lifestyle medications and drugs with over-the-counter (OTC) equivalents or alternatives. Advantage Pharmacy generally does not cover these medications; however, benefits may vary. Please refer to your Summary Plan Description for details on your specific plan. This list may not be all inclusive and is subject to change at any time.
TherapeuTiC CaTeGory
TherapeuTiC CaTeGory
Non-Sedating Antihistamines Al egra/Al egra D examples
The fol owing is a list of common Tier 3 drugs and the Tier 1 and Tier 2 preferred alternatives. Remember, to help manage prescription costs, always try to use generic (Tier 1) and preferred brand-name (Tier 2) whenever possible. estrogen / methyltestosterone, Covaryx, EEMT THIS DOCUMENT IS EFFECTIVE JULY 1, 2010, AND IS SUBJECT TO CHANGE. Chemotherapy agents, diabetic needles, syringes and swabs have Tier 1 or Tier 2 options available. Also, most generics are available at the lowest copay. You can get more information and updates to this document by visiting the Web site listed on your member ID card. “CIGNA” and the “Tree of Life” logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by CIGNA Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Tel-Drug, Inc. and its af iliates, CIGNA Behavioral Health, Inc., Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. In California, HMO plans are offered by CIGNA HealthCare of California, Inc. and Great-West Healthcare of California, Inc. Al other medical plans in California are insured or administered by CGLIC. CGLIC has acquired the business of Great-West Healthcare.

Source: http://www.uccs.edu/Documents/shc/advantagepharmacy.pdf