Preferred brand drugs are covered on Tier 2, and nonpreferred brands are covered on Tier 3 and/or Tier 4. Premium Preferred Drug List (PDL) Closed Formulary –
Cigna Healthcare Value 3-Tier Prescription Drug List. TIER 1. $. TIER 2. $$. TIER 3. $$$. CHOLESTEROL MEDICATIONS amlodipine- atorvastatin atorvastatin 10mg.
When you request a Drug List, tier, or utilization restriction exception you Tier 2 includes preferred brands and certain higher-cost generics. Tier
the Drug List for the new benefit year for any changes to drugs. The = Tier 2: Generic Drugs. 3. = Tier 3: Preferred Brand Drugs. 4. = Tier 4: Non
Many tier 3 drugs have lower-cost options in tier 1 or 2. Ask your doctor if they could work for you. Drug list information. In this drug list, some medications
This Blue Cross KeyRx list shows prescription drug products in tiers. Each drug is placed into one of four member payment tiers: Tier 1, Tier 2, Tier 3, and Tier 4. Note: Depending on your
Cigna Healthcare Performance 3-Tier Prescription Drug List. TIER 1. $. TIER 2. $$. TIER 3. $$$ DIABETES (cont.) EASY TOUCH. FLIPLOCK INSULIN. EASY TOUCH.
A prescription drug formulary, which is a list of covered Tier 1, Tier 2 and Tier 3 drugs and specialty prescription drugs. Page 2. has been developed by
Drug Lists by Tier. Cigna Standard Prescription Drug List. 3 Tier [PDF] 4 Tier (injectable specialty medications covered on tier 4) [PDF] 4 Tier (all
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