Employees and dependents covered under the Arkansas State University System's health plan are covered under the Cigna Formulary. There are significant changes to the 2018 formulary including elimination of some drugs, and tier changes on others. (2018 Changes.)
Most drugs covered under the formulary may be filled at in-network pharmacists by paying the following copays:
|$12 Tier 1 (generic)|
|$35 Tier 2 (preferred) ($50 effective 1.1.2018)|
|$60 Tier 3 (non-preferred) ($80 effective 1.1.2018)|
|$0 for generic contraceptives*|
Some drugs require additional approval in order to be covered under our plan. These include:
- Some Tier 3 drugs require step therapy. Step therapy ensures that members use clinically appropriate drugs in a cost-effective manner by requiring the member to try a generic medication prior to obtaining the brand medication in certain drug classes.
- Effective 9/1/2017, specialty drugs may be purchased at some pharmacies or by mail order. This does not include specialty drugs that are covered under the medical, rather than pharmacy, such as infusion drugs. Choosing your local pharmacy may actually cost the plan less than the mail order price, which helps keep premiums affordable for all. You may compare the cost to the plan at www.mycigna.com
Compounded drugs are not covered under our medical plan.
In an effort to control pharmacy costs, sometime a drug may be removed from the formulary if another drug from another manufacturere is available at a lower price. If you are currently taking a drug that is going to be removed, you and your physician will receive a 60 day notification so that your physician may change your prescription to the alternative medication.
A new benefit under Cigna allows you to fill some maintenance medications for 90 days with two copays. You must use a Cigna 90 Now pharmacy or mail order. Pharmacies not part of the Cigna 90 Now program will not be able to fill your 90 day prescription under the plan. Pharmacy prices may be lower than mail order prices. You may compare the costs to you and the plan at www.mycigna.com.
Some contraceptives and other preventive medications have a $0 copay. The generic contraceptives on the Cigna Formulary (page 5) have either a $12 copay or a $0 copay depending on whether or not they are are included in the no cost-share preventive medications. Preferred (Tier 2) contraceptives have a $35 copay ($50 effective 1.1.2018( and Non-preferred (Tier 3) contraceptives have a $60 copay ($80 effective 1.1.2018).
(Note: Some members have reported not having to pay a copay in 2016 for brand contraceptives. Our 2016 plan coverage on page 43 of the PLAN DOCUMENT AND SUMMARY PLAN DESCRIPTION FOR ARKANSAS STATE UNIVERSITY SYSTEM EMPLOYEE HEALTH BENEFIT PLAN was as follows: "BENEFIT LIMITS (1) Contraceptives coverage is limited to a list of product specific rings, patches, diaphragms and prescribed generic oral contraceptives, at no cost. At all times, this Plan will comply with the Affordable Care Act." If a member's copay for a contraceptive not on the limited list of covered contraceptives, the 2016 the prescription was not filled in accordance with our plan document.)