Cigna Releases Formulary Changes for 2022

Cigna will be removing 45 drugs covered under the pharmacy benefit from its Standard Prescription Drug List beginning in January 2022. Cigna officials said that less than 1% of customers will be impacted by these changes, and drugs are removed if there are therapeutic alternatives that are more affordable.

Formulary decisions are driven first by clinical considerations made by an independent committee of actively practicing physicians and pharmacists, a Cigna spokesperson said by email.

“We are committed to lowering drug costs for our customers and clients, so every year, we review our formularies to remove or manage certain high-priced drugs where clinically appropriate alternatives are available,” the spokesperson said.

Most of the drugs that will be removed have generic alternatives. (See table below.)

For medications that don’t have an available generic available, Cigna recommends a different branded therapeutic. For example, among diabetes medications removed from the standard formulary are Janssen’s Invokana and Invokamet, as well as Merck’s/Pfizer’s Segluromet and Steglatro. For Invokana (canagliflozin) and Steglatro (ertugliflozin), the recommended alternative is Farxiga (dapaglifozin), which has a list price of $532 for a 30-day supply. For the combination products Invokamet (canagliflozin/metformin) and Segluromet (ertugliflozin/metformin), the recommended alternative is Synjardy (empagliflozin/metformin), which has a list price of $582 for a 60-day supply.

Among cholesterol medications removed from the standard formulary are Crestor (rosuvastatin), where there is a generic available, and Juxtapid (lomitapide). Because there is no generic for Juxtapid, Cigna recommends Amgen’s Repatha (evolocumab), where the list price is less than $500 a month. Juxtapid has a list price of almost $50,000 for 28 capsules.

Additionally, Cigna will move four therapeutics to a higher, non-preferred drug tier in 2022, and another four drugs have moved to a lower, preferred tier. Moving to the non-preferred tier are Apokyn, Remodulin, Sandostatin LAR, and Tasigna.

Apokyn (apomorphine) is indicated for the acute, intermittent treatment of hypomobility during “off” episodes in patients with advanced Parkinson’s disease. It is marketed by Supernus Pharmaceuticals. Levodopa is used to manage patients with Parkinson’s disease, but it can become less effective over time, and patients can experience a diminished clinical response marked by motor fluctuations. Cigna recommends Sunovion’s Kynmobi (apomorphine) as an alternative. The FDA approved Kynmobi in October 2020. It is a novel formulation of apomorphine that is delivered through a thin film that dissolves under the tongue.

Remodulin (treprostinil), developed by United Therapeutics, treats patients with pulmonary arterial hypertension. Cigna recommends using a generic treprostinil. Sandoz launched the first generic of trepostinil injection in 2019, and in May 2021, Sandoz launched a subcutaneous version.

Both Sandostatin and Tasigna are used by patients with cancer. Novartis’ Sandostatin LAR Depot (octreotide) treats severe diarrhea associated with metastatic tumors. Cigna recommends another Novartis therapeutic instead: Somatuline Depot (lanreotide). Tasigna (nilotinib), also developed by Novartis, treats patients with chronic myeloid leukemia. Cigna recommends Sprycel (dasatinib) from Bristol Myers Squibb as an alternative.

Moving to a lower tier are the COPD therapies Spiriva/Spiriva Respimat and Stiolto Respimat, as well as the biosimilars Udencya (pegfilgrastim-cbqv) and Ziextenzo (pegfilgrastim-bmez), which are used to prevent infection after chemotherapy.

Fourteen therapies now have coverage restrictions, including needing approval from Cigna. For several medications for age-related macular degeneration, physicians will have to show that patients have already tried Avastin (bevacizumab). These include Beovu (brolucizumab-dbll), Eylea (aflibercept), and Lucentis (ranibizumab).

Some diabetes medicines will require current patients to have approval from Cigna to continue on these therapeutics. These include Bydureon/Byetta (exenatide), Ozempic/Rybelsus (semaglutide), and Victoza (liraglutide).