30 Frequently Asked Questions (FAQs) (cont.) • QL (Quantity Limit) next to it, you may need approval depending on how much you’re filling at one time. • AGE (Age Requirement) next to it, you may need approval depending on your age. Q. What types of medications typically need approval? A. Medications that: • May not be safe when you take them with other medications. • Have lower-cost alternatives that work just as well at treating the same condition. • Should only be used for certain health conditions. • Are often used in the wrong way or are abused (taken more often than you should). Q. What types of medications typically have quantity limits? A. Medications that are often: • Taken in a greater amount or used for a longer time than they should be. • Used in the wrong way or are abused (taken more often than you should). Q. What medications are part of Step Therapy? A. They’re typically high-cost medications that treat conditions such as: • ADD/ADHD • High cholesterol • Allergies • Osteoporosis • Bladder problems • Pain • Breathing problems • Skin conditions • Depression • Sleep disorders • High blood pressure Q. Why does my medication have an age requirement? A. Not all medications are right for all ages. Some medications work best for people of a certain age or within a certain age range. As you get older, body changes can decrease the body’s ability to break down or get rid of certain medications. This means that the medication may stay in your body longer. So, an older adult may need a lower dose of the medication or a different medication that’s safer. Q. How do I get approval (prior authorization) for my medication? A. Ask your doctor’s office to contact us to start the coverage review process. They know how the review process works and will take care of everything for you. In case the office asks, they can download a request form from our provider portal at cignaforhcp.com. We’ll review the information your doctor sends us to make sure you meet the medication's coverage rules (requirements). We’ll send you and your doctor a letter with our decision (approved/not approved) and next steps. It can take up to five (5) business days to hear from us. You can always check with your doctor’s office to find out if we’ve made a decision. Or, you can log in to the myCigna App or myCigna.com to see where your medication is in the review process or to read about the decision we made. Many times, we don’t get all of the information we need from the doctor’s office to approve coverage. If we don’t approve your medication, your doctor can send us more information to review, using the same process as before. We’re happy to review the request again. Depending on what your doctor sends this time, we may be able to approve coverage. Or you and your doctor can appeal the decision by sending us a request, in writing, that explains why we should cover the medication. Q. What happens if I try to fill a prescription that needs approval, but I don’t get it ahead of time? A. When your pharmacist tries to fill your prescription, they’ll see that the medication needs our approval before it can be covered. Because you didn’t get approval ahead of time, your plan won’t cover its cost. If that happens, ask your doctor to contact us to start the coverage review process. You can still fill it (without using your plan/insurance), but you’ll pay its full price at the pharmacy counter. And, if you do this, your costs can’t be applied to your annual deductible or out-of-pocket maximum. Q. What happens if I try to fill a prescription that has a quantity limit? A. Your pharmacist will only fill the amount your plan covers. If you want to fill more than what’s allowed,