Cigna Issues Changes in Drug Formulary and Management

January 2020 ~

Cigna announced it will be updating its drug formulary, in an effort to help ensure customers have access to affordable, clinically appropriate drug therapy options.

The following drug formulary updates became effective as of January 1, 2020:

• Acne tetracyclines – Cigna will no longer cover kits containing over-the-counter (OTC) medications. Cigna will also remove the high-cost ORACEA^® brand and its generic (doxycycline, 40 mg capsule) from formularies to drive use of lower-cost alternatives.
• Asthma anti-inflammatories – Cigna will make XOLAIR^® a preferred-brand drug.
• Asthma and chronic obstructive pulmonary disease (COPD) inhalers – Cigna will remove SPIRIVA^®, STIOLTO^®, and STRIVERDI^® from formularies to drive customers to lower-cost alternatives. Cigna will add SEREVENT^® DISKUS^® as a preferred-brand drug.
• Attention deficit hyperactivity disorder (ADHD) – For some of plans, Cigna will add a prior authorization requirement to ensure appropriate use of covered drugs, as well as other requirements (e.g., six-month evaluation).
• Birth control – Cigna will make NuvaRing^® a preferred-brand drug.
• Bowel prep kits – Cigna will add CLENPIQ®, PREPOPIK^®, and SUPREP^® as preferred-brand drugs. Cigna will move several brand-name drugs from formularies or to nonpreferred-brand drugs.
• Cancer – Cigna will remove ZYTIGA^® (250 mg and 500 mg) and Tarceva^® from formularies in response to generic launches. Cigna will add Erlotinib to tier one with specialty prior authorization, and Erivedge^® as a preferred-brand drug.
• Cardiovascular beta blockers – To align utilization management with Express Scripts, Cigna will add step therapy to all brand-name oral beta blockers. The biggest impact will be for customers who take BYSTOLIC^®.
• Cystic fibrosis antibiotics – To ensure inhaled antibiotics are prescribed in accordance with U.S. Food and Drug Administration (FDA) indications, Cigna will add quantity limits and a specialty prior authorization requirement to all products.
• Diabetes – Cigna will add certain diabetes-branded drugs as preferred-brand drugs to improve their access, and remove other diabetes-branded drugs and high-cost generics to encourage use of lower-cost alternatives. (Cigna will grandfather current users of alogliptin, alogliptin/metformin, and alogliptin/ pioglitazone indefinitely.) Cigna will add quantity limits on insulins. Metformin will be Cigna’s first-choice treatment for type 2 diabetes due to its safety, efficacy, and potential cardiovascular benefits.
• Human immunodeficiency virus (HIV) – Cigna will encourage customers who are newly diagnosed with HIV to use Cigna’s preferred drugs that are single-tablet regimens to help improve adherence. Customers who are currently prescribed multisource brand drugs will be encouraged to move to a lower-cost generic when an exact generic alternative to the brand product is available. In addition, Cigna will add a prior authorization requirement for customers who are newly diagnosed with HIV and starting medications for it, except for the drugs listed below.
  • BIKTARVY^®, DOVATO, GENVOYA^®, Symfi®/Symfi lo^®, and TRIUMEQ^®.
  • The four regimens used for post-exposure prophylaxis:
    • TRUVADA^® and TIVICAY^®
    • TRUVADA and ISENTRESS^®
    • TRUVADA, PREZISTA^®, and NORVIR^®
    • Renal failure regimens

Cigna will also add DOVATO and Symfi/Symfi lo as preferred-brand drugs, and remove several multisource brand drugs from formularies to encourage the use of generics.

• Inflammatories – Cigna will add quantity limits to all oral and self-injectable anti-inflammatory products. Cigna will use integrated data (Cigna Rx Claim Connect) to identify certain conditions, and allow higher dosing of the following drugs for the specified indications: CIMZIA^® (chronic plaque psoriasis), HUMIRA^® (rheumatoid arthritis, Crohn’s disease, and hidradenitis suppurativa), and STELARA^® (Crohn’s disease).
• In vitro fertilization – GONAL-f^® will be the preferred drug for both the medical benefit and the pharmacy benefit. As the preferred product at Freedom Fertility Pharmacy, a Cigna specialty pharmacy. This will make the therapy more affordable and accessible to customers. Cigna will add Follistim^® AQ to the nonpreferred-brand tier for pharmacy and medical.

The insurer notes that as a result of the Cigna’s combination with Express Scripts, Cigna is able to include more preferred brand drugs in key classes, and will add additional clinical utilization management edits for immediate increased savings, quality, and safety for your patients. These updates will help ensure customers have access to affordable, clinically appropriate drug therapy options.

Source(s): Network News: October 2019;