Page 9 - NRDC Benefits Guide for 2022

Prescription Drug Coverage

Whether you’re taking medications now or in the future, it’s important to know which medications your
plan covers. Cigna makes it easy by providing up-to-date drug lists online.

Follow these simple steps to find out how your plan covers your medication(s).
1. Go to Cigna.com/druglist.
2. Select Standard 3 Tier drug list from the drop-down menu.

3. Choose a search method: Type in your medication name and click Search or look for your medication name
in the alphabetical list.

Open Access Plus Plan Open Access Plus HDHP Plan
Prescription and Mail Order You Pay You Pay You Pay You Pay
Coverage*
In Network Out of Network In Network Out of Network
30-Day Supply (Retail)
$10 co-pay After
Tier 1 $10 co-pay Not Covered Not Covered
Ded.
$20 co-pay After
Tier 2 $20 co-pay Not Covered Not Covered
Ded.
$30 co-pay After
Tier 3 $30 co-pay Not Covered Not Covered
Ded.
90-Day Supply (Mail Order or Retail Maintenance)
$25 co-pay After
Tier 1 $25 co-pay Not Covered Not Covered
Ded.
$50 co-pay After
Tier 2 $50 co-pay Not Covered Not Covered
Ded.
$75 co-pay After
Tier 3 $75 co-pay Not Covered Not Covered
Ded.
Your prescription medicines can be sent directly to you by mail—a great convenience for medications
you take on an ongoing basis, such as those used to treat chronic conditions like high blood pressure
or diabetes. Additionally, you could save money by using the mail order pharmacy.
*Certain medications that treat chronic conditions may be covered subject to co-pay only (not subject to
deductible) under the HDHP plan

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