10 Cigna Healthcare Advantage 3-Tier Prescription Drug List Generic medications are listed in all lowercase letters and brand-name medications are listed in all CAPITAL letters. Tier 1 – Generics PA – Prior Authorization AGE – Age Requirement OC – Optional Coverage Tier 2 – Preferred Brands QL – Quantity Limit SP – Specialty Medication Tier 3 – Non-Preferred Brands ST – Step Therapy PPACA – No Cost-Share Preventive Medication CANCER Medication Tier Notes abirtega 1 PA AKEEGA 3 SP, PA, QL ALECENSA 2 SP, PA, QL ALUNBRIG 2 SP, PA, QL anastrozole 1 PPACA AYVAKIT 3 SP, PA, QL BOSULIF 3 SP, PA, QL BRUKINSA CAPSULE 2 SP, PA, QL CABOMETYX 2 SP, PA CALQUENCE 2 SP, PA capecitabine 1 SP, PA COMETRIQ 3 SP, PA, QL COTELLIC 2 SP, PA DANZITEN 2 SP, PA ELIGARD 3 SP ERIVEDGE 2 SP, PA ERLEADA 2 SP, PA exemestane 1 PPACA FRUZAQLA 2 SP, PA, QL GAVRETO 3 SP, PA, QL GLEOSTINE 2 HERCESSI 3 SP, PA hydroxyurea 1 IBRANCE 3 SP, PA, QL imatinib 1 SP, QL IMBRUVICA 2 SP, PA, QL IMKELDI 2 SP, PA INLYTA 3 SP, PA JAKAFI 3 SP, PA, QL JYLAMVO 3 KANJINTI 2 SP, PA KISQALI 2 SP, PA, QL KOSELUGO 3 SP, PA, QL CANCER (cont.) Medication Tier Notes lenalidomide 1 SP, PA, QL LENVIMA 2 SP, PA letrozole 1 leucovorin 1 LONSURF 3 SP, PA LORBRENA 3 SP, PA, QL LUMAKRAS 3 SP, PA, QL LYNPARZA 2 SP, PA, QL MEKINIST 2 SP, PA, QL mercaptopurine tablet 1 methotrexate 1 MVASI 2 SP, PA NERLYNX 3 SP, PA NINLARO 3 SP, PA, QL NUBEQA 2 SP, PA ODOMZO 2 SP, PA OGIVRI 2 SP, PA OGSIVEO 3 SP, PA, QL ONTRUZANT 3 SP, PA ORGOVYX 3 SP, PA ORSERDU 3 SP, PA, QL PHESGO 3 SP, PA PIQRAY 2 SP, PA POMALYST 2 SP, PA, QL PURIXAN 3 SP RETEVMO 3 SP, PA, QL REVLIMID 2 SP, PA, QL RIABNI 2 SP, PA ROZLYTREK 3 SP, PA RUBRACA 2 SP, PA, QL RUXIENCE 2 SP, PA RYDAPT 3 SP, PA SCEMBLIX 2 SP, PA, QL