Specialty Pharmacy Management Across Benefits

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Specialty Pharmacy Management Across Benefits

Controlling costs with whole-person support.

At Cigna, we know managing specialty pharmacy costs goes well beyond just the unit cost of a drug. From site of care, specialists, hospitalizations, comorbidities, and mental health conditions, supporting our customers and clients holistically is critical to help ensure the best health outcomes and lowest total medical costs.

Managing spend for the most costly conditions

With integrated medical, pharmacy, and behavioral benefits we use advanced analytics, real-time data, and a whole-person view to provide proactive solutions that support the body and mind, driving better health and financial outcomes.

  • Lowest net cost strategy and a focus on biosimilars to manage high cost specialty drugs
  • Medical pharmacy cost management through site of care, buy and bill, and aggressive doctor fee schedules
  • Optimized utilization of manufacturer copay assistance programs, improving customer choice and adherence

Whole-person support for patients with the most complex needs

With integrated benefits and consistent coverage policies across both medical and pharmacy, we are able to provide our customers with personalized, proactive support to help them achieve their best health.

  • 99% limited and exclusive specialty drug access to therapies critical to customers with rare and complex conditions1
  • Dedicated, proactive copay assistance teams – Accredo helped customers connect with $850M in financial assistance in 20192
  • Access to over 500 condition-focused pharmacists and 600 home infusion nurses, across 15 specialty Accredo Therapeutic Resource CentersSM (TRCs)3 each with extensive training and experience in specific disease states and medications

Accreditation

Cigna has earned full URAC Specialty Pharmacy Accreditation validating our service, safety and improvement-oriented processes and programs.

199.1% access to specialty drugs through Accredo. Based on a 2018 analysis of Express Scripts adjudicated claims volume for commercial and health plan payers for limited distribution, exclusive distribution, and open access specialty drugs.

2Express Scripts book of business data 2019.

3Accredo operations data, 2019. Subject to change.

Pharmacy benefit plans and management services are offered by Cigna Health and Life Insurance Company (CHLIC), Express Scripts, Inc., or their affiliates. “Accredo” refers to Accredo Health Group, Inc., a Cigna company. Accredo and Therapeutic Resource Centers are service marks of Express Scripts Strategic Development, Inc. Plans contain exclusions and limitations and may not be available in all areas. For costs and details of coverage, contact a Cigna representative. CHLIC policy forms: OK - HP-APP-1 et al., OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al.