Pharmacies
What is our preferred mail order pharmacy for Cigna members?
Express Scripts Pharmacy
Approximately how many days are checks mailed after a claim is processed?
6 to 12 days
This restriction means the plan has a "predetermined standard amount" that they will cover on a monthly basis. If the customer requires more than this amount, a coverage determination request is required.
Quantity Limit
This type of appeal is processed within 7 days of receiving the request.
Standard Appeals
It is an establishment or facility where prescription medications, over-the-counter drugs, and other healthcare-related products are dispensed or sold to customers.
Pharmacy/Pharmacies
These are medicinal products intended for the diagnosis, prevention, or treatment of life-threatening or very serious diseases or disorders that are rare.
Orphan Drugs
It refers to any decision made by or on behalf of a Part D plan sponsor concerning the payment or benefits that an enrollee believes they are entitled to.
Coverage Determination
It is a formal way of asking the plan to review and reconsider an unfavorable coverage determination result.
Appeals
A type of pharmacy that DOES NOT have contracts or agreements with a specific health insurance plan, pharmacy benefit manager (PBM), or healthcare organization.
Out-Of-Network Pharmacy/Pharmacies
Are customers required to fill out a claim form in order to receive reimbursement?
No. (It is optional.)
What time does CDU open?
give the complete time CDU is open to receive requests.
8am to 2am Est, Monday - Friday;
8am to 8pm Est, on Saturdays
What is the timeframe for the expideted appeals process?
72 hours
A type of pharmacy that has ESTABLISHED contracts or agreements with a specific health insurance plan, pharmacy benefit manager (PBM), or healthcare organization.
In-Network Pharmacy/Pharmacies
It is a process in which a member of a health insurance plan pays for covered healthcare services out of pocket and then submits a claim to the insurance company for reimbursement.
DMR (Direct Member Reimbursement)
Can we mail a form for CD requests?
No.
Can you still file an appeal if its already 90 days past receiving the denied CD request?
No.
The advantage of this pharmacy is you can have free expedited shipping in weather-resistant, tamper-evident packages along with special handling (like refrigeration) for SPECIALTY prescriptions, so your medication arrives exactly as it should.
ACCREDO Specialty Pharmacy
The majority of DMR claims are processed within how many days?
one - three days
How many days of a transitional benefit supply may the customer receive?
30 days
Who processes the fourth-level appeal?
Medicare Appeals Council