Cigna Pharmacy’s January 2021 formulary and UM strategy

Plan affordability is the key imperative of Cigna's January 2021 formulary and Utilization Management (UM) changes. Our low net drug cost formulary and UM management approach is an integral part of achieving this enterprise goal for clients and customers.

For January 2021, there are a number of changes to achieve better formulary affordability and improved pharmacy plan performance for clients. These focus on:

  • Removal of egregiously priced drugs – We lower overall claims costs by removing certain drugs with hyper-inflated costs from our formularies, regardless of drug company incentives.
  • Promotion of generic and over-the-counter (OTC) drugs – New generics to market create opportunity to use lower cost to improve medication adherence. We will initiate edits for various drugs/conditions.
  • Promotion of low cost therapeutic alternatives – Many high-cost drugs have viable alternatives. We promote these through a targeted formulary and UM strategy.

Read more about Cigna’s formulary and UM strategy updates.

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Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. Some plans require use an in-network pharmacy for prescriptions to be covered. Coverage is subject to any plan deductible, copayment and/or coinsurance requirements. Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and complete details of prescription drug coverage, contact a Cigna representative.

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