Cigna Secure Essential Rx (PDP) 2021 Annual Notice of Changes

The 2021 Annual Notice of Changes (NOC) for the Cigna Secure Essential Rx Prescription Drug Plan (PDP) outlines the updates that will take effect on January1,2021. This document is required by the Centers for Medicare & Medicaid Services (CMS) and provides members, caregivers, and healthcare professionals with a clear summary of any modifications to benefits, costs, formularies, and other plan features.

Why the Notice Matters

For Medicare beneficiaries, the NOC is the primary source of information when evaluating whether a prescription drug plan still meets their healthcare needs and budget. Changes can affect medication access, outofpocket costs, and pharmacy choices. Understanding each section of the notice helps members make informed decisions during the annual enrollment period.

Key Highlights of the 2021 Changes

1. Benefit Design Adjustments

• Initial Coverage Limit (ICL): The ICL remains at 30days supply for generic drugs and 90days supply for brandname drugs, but the plan now waives the ICL for certain specialty medications when prior authorization is approved.
• Coverage Gap (Donut Hole) Discount: The plan continues to provide a 75% discount on brandname drugs and a 95% discount on generics while in the coverage gap, in line with Medicare PartD requirements.
• OutofPocket (OOP) Maximum: The annual OOP limit is $5,250 for 2021, a $150 increase from 2020.

2. Premium Changes

The monthly premium for single coverage will increase from $25.00 to $28.00. For dualeligible members (those also enrolled in Medicaid), the premium remains $0 because the state Medicaid agency pays the cost.

3. Formulary Updates

A new formulary effective January1,2021 includes the following noteworthy changes:

4. Prior Authorization & Step Therapy

Starting in 2021, the plan expands step therapy protocols for certain highcost specialty drugs. If a lowercost alternative is available and approved, the prescribing clinician must try that before the specialty medication is dispensed. A list of affected drugs is available on the Cigna website and in the member handbook.

5. Pharmacy Network Modifications

• Retail pharmacy network now includes an additional 250 independent pharmacies, improving access in rural areas.
• Mailorder pharmacy benefits remain unchanged; members can receive a 90day supply of maintenance medications at no additional shipping charge.

6. COVID19 Related Provisions

To support members during the pandemic, the plan will:

• Provide a onetime $25 credit for members who experience a COVIDrelated medication interruption.
• Allow a 30day refill extension for chronic medications without prior authorization.

How These Changes May Affect You

Cost Implications: The modest premium increase is offset for many members by the higher OOP maximum, which may reduce surprise expenses for highcost drugs.

Medication Access: New formulary additions expand treatment options for depression, diabetes, and cancer, while steptherapy requirements could require additional communication with prescribers.

Convenience: The expanded retail network and continued mailorder service aim to make it easier to pick up prescriptions, especially for those with limited transportation.

What You Should Do Next

1. Review your current medication list against the updated formulary. Look for any drugs that have moved tiers or require prior authorization.
2. Contact your prescriber to discuss alternative therapies if a medication is now subject to step therapy.
3. Log in to Cignas member portal to view your personalized drug cost estimates for 2021.
4. If the changes increase your costs or limit access to a needed medication, consider switching plans during the Medicare annual enrollment period (Oct15 Dec7,2021).
5. Call the member services line at 18005551234 for assistance with understanding the new benefits or for help filing a priorauthorization request.

Where to Find More Information

The full 2021 Annual Notice of Changes is available in PDF format on the Cigna website. Additional resources include:

• Member Handbook (downloadable PDF)
• Online Formulary Lookup Tool
• FAQs about COVID19 Pharmacy Benefits
• Contact Center 24hour support for prescription inquiries

Staying informed helps you keep control of your healthcare costs and ensures you continue to receive the medications you need. Review the notice carefully and reach out for help if anything is unclear.