9 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 BLOOD PRESSURE/HEART MEDICATIONS (cont.) Medication Tier Notes amlodipine-valsartan 1 atenolol 1 bisoprolol 5 mg, 10 mg tablet 1 bisoprolol-hctz 1 CAMZYOS 3 SP, PA, QL candesartan 1 carvedilol 1 carvedilol er 1 QL clonidine patch, tablet 1 CORLANOR ORAL SOLUTION 2 SP, PA diltiazem 24hr er (cd) 1 dofetilide 1 QL droxidopa 1 SP enalapril 1 ENTRESTO SPRINKLE 2 flecainide 1 guanfacine 1 hydralazine 1 irbesartan 1 labetalol carpuject; 20 mg/4 ml syringe; 100 mg, 200 mg, 300 mg tablet; vial 1 lisinopril 1 lisinopril-hctz 1 losartan 1 losartan-hctz 1 metoprolol 1 metoprolol er 1 metyrosine 1 PA midodrine 1 minoxidil tablet 1 MULTAQ 2 BLOOD PRESSURE/HEART MEDICATIONS (cont.) Medication Tier Notes nadolol 1 nebivolol 1 QL nifedipine er 1 NITROSTAT 3 NORLIQVA 2 PA, QL olmesartan 1 QL olmesartan-amlodipine-hctz 1 olmesartan-hctz 1 QL ORLADEYO 3 SP, PA, QL prazosin 1 propranolol 1 propranolol er 1 ranolazine er 1 QL telmisartan 1 QL telmisartan-hctz 1 QL valsartan 1 valsartan-hctz 1 verapamil er 1 verapamil sr 1 VERQUVO 2 PA, QL BLOOD THINNERS/ANTI-CLOTTING Medication Tier Notes clopidogrel 1 dabigatran 1 ELIQUIS 2 enoxaparin 1 SP, QL fondaparinux 1 SP, QL FRAGMIN 3 SP, QL prasugrel 1 warfarin 1 XARELTO 2 ZONTIVITY 3