28 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 VACCINES (cont.) Not all plans cover vaccines in the same way. Log in to the myCigna App or myCigna.com, or check your plan materials, to see how your plan covers them. Medication Tier Notes PENTACEL 3 PPACA PENTACEL ACTHIB COMPONENT 3 PPACA PFIZER COVID 3 PPACA PNEUMOVAX 23 3 PPACA PREHEVBRIO 3 PPACA PREVNAR 20 3 PPACA PRIORIX 3 PPACA PROQUAD 3 PPACA QUADRACEL DTAP-IPV 3 PPACA RECOMBIVAX HB 3 PPACA ROTARIX 3 PPACA ROTATEQ 3 PPACA SHINGRIX 3 QL, PPACA SPIKEVAX COVID 3 PPACA TDVAX 3 PPACA TENIVAC 3 PPACA TRUMENBA 3 PPACA TWINRIX 3 PPACA VARIVAX 3 PPACA VAXELIS 3 PPACA VAXNEUVANCE 3 PPACA VITAMINS Medication Tier Notes CITRANATAL MEDLEY 3 POLY-VI-FLOR 3 PPACA POLY-VI-FLOR WITH IRON CHEWABLE TABLET 3 PPACA