Cigna Healthcare (now part of The Cigna Group, which also includes Express Scripts) uses Express Scripts as its pharmacy benefits manager. This integration means Cigna's formulary is managed by one of the largest PBMs in the country. Cigna offers multiple formulary options for employer plans, ranging from broad open formularies to more restrictive value formularies.
Key Facts
Check Your Specific Plan's Formulary
Coverage varies by plan. Use our formulary checker tool to look up your exact copay and restrictions.
Open Formulary CheckerSources and standards behind this page
Drug coverage in the United States is governed by published rules rather than by any one insurer's summary, and the sources below are the primary ones. They are linked so a reader can check a claim without taking this page's word for it.
- FDA Orange Book publishes the therapeutic-equivalence ratings that decide whether a generic may be substituted for a brand-name drug.
- FDA generic drug facts sets out what "generic equivalent" means and what a manufacturer must prove.
- CMS prescription drug coverage defines the rules a Medicare drug plan formulary must follow and how it may change mid-year.
- Medicare.gov drug coverage (Part D) states what a Part D plan is required to offer a member.
- CMS prescription drug appeals documents the coverage-determination and exception process when a drug is denied.
This page describes how coverage and formularies work. It is not medical advice, and a reader's own plan documents and prescriber decide what applies to them.
Frequently Asked Questions
Visit mycigna.com and navigate to Coverage, then Prescription Medications. Enter your drug name to see tier placement, copay, and any restrictions. You can also use the Express Scripts app. Your specific formulary depends on your employer's chosen plan design.
The Open formulary covers the most drugs with fewer restrictions. The Performance formulary is moderately restrictive with preferred alternatives. The Value formulary is the most restrictive, covering fewer brand-name drugs and requiring more step therapy and prior authorizations, but offers the lowest premiums.
Cigna's coverage of compounded medications is limited. Most plans require prior authorization for compounds, and many topical compounds are excluded. Coverage depends on your specific plan and whether the compound contains FDA-approved ingredients without commercially available alternatives.
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