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Cigna Pharmacy Benefits

Driving integrated value and improved care

Getting ahead in today's dynamic pharmacy landscape requires new thinking, a fresh approach, and truly coordinated care that goes well beyond drug unit costs. Customers need to be engaged, solutions must drive value, and the experience must be simple.

  • $74 medical savings per member per year (PMPY) by integrating pharmacy with medical as proven by external 2017 third party study1
  • Lowest medical cost trend among our national competitors since 20102
  • 0% commercial drug trend in 20173

How we do it:

Purposeful Engagement

Our shared clinical platform for both medical and pharmacy provides actionable, real-time access to customer insights across all benefits. This foundation of coordinated care and increased customer engagement allows for personalized coaching and effective condition management.

  • $253 average medical savings PMPY for those with a health improvement opportunity1
  • 12% higher rates in participation and completion of activities in the Cigna case management or health coaching programs1
    • $4,400 PMPY savings for customers taking specialty drugs1
    • $2,800 PMPY savings for customers with Diabetes1

Value-driven Solutions

Total Specialty Drug Management

If you're only looking at specialty costs under the pharmacy benefit, you could be overlooking 67% of your total specialty drug costs4. The only way to truly manage specialty spend is to look across and manage specialty drugs between both the pharmacy and medical benefit. Our integrated platform helps ensure that customers get the right therapy, at the right site of care, for the best price, and achieve the best health outcome. Learn more.

Cigna customers using our specialty pharmacy vs. using retail realize:5

  • 7% or higher medication adherence
  • 20% higher engagement
  • 11% estimated overall lower medical costs
  • $98M estimated savings for 900 customers with our Site of Care Management Program6
Formulary and Plan Design Optimization

A disciplined and active formulary strategy is an important focus at Cigna. Our Low Net Cost formulary strategy helps lower pharmacy claims costs by moving drugs with hyper-inflated costs and viable alternatives off formulary, regardless of pharmaceutical company incentives. We believe it's the right action for our customers and clients. Learn more.

  • $42 per member per year (PMPY) savings with Cigna Formulary strategies7
  • Cigna 90 Now offers deep discounts for routine medication fills
  • Cigna Designed Rx gives employees convenience, protection and cost-effective options. Average annual savings realized per member per month (PMPM) include8:
    • $9.40 PMPM for Basic savings package
    • $8.20 PMPM for Balanced savings package
    • $4.80 PMPM for Max savings package
Clinical Oversight

Our clinicians use real-time pharmacy insights, benefit and formulary information to look at the whole customer providing aid and support. The following programs are offered at no additional cost with combined medical and pharmacy benefits:

  • Comprehensive Utilization Management helps protect against drug misuse through quantity limits, prior authorization, and step therapy
  • Gaps in Care focuses on health coach intervention for adherence issues and other gaps for those with certain chronic conditions
  • Drug Cost Tool on lets customers find real-time, personalized cost comparisons for prescription drugs and pharmacies
  • Narcotic therapy management program prescriber engagement and customer support for those who may be at risk for opioid use disorder

Simplified Experience

Our ability to connect and coordinate pharmacy and medical benefits though one unified platform allows us to simplify the experience for both client and customer.

  • One dedicated team providing guidance and consultative reporting across both medical and pharmacy
  • Coordinated insights drive employee engagement, improved outcomes and savings

Save money with the right mix of benefits - at the right price

Contact your broker or your Cigna representative to discuss your organization’s unique needs.
  1. Cigna 2017 National Book of Business study of medical customers who have Cigna pharmacy benefits vs. those with Cigna medical only.
  2. Based on Cigna and top three national competitors' 2010-Q3 2017 analyst calls - publicly available information. If no specific guidance was given, the midpoint of the reported range was used.
  3. Pharmacy benefit trend analysis conducted January 2018 includes pharmacy trends, net of rebates for our managed drug lists (Standard & Value) - excludes IFP, Legacy drug list, and client-specific drug lists.
  4. Cigna specialty medication users, integrated pharmacy and medical benefits claim review. Integrated Data Source January-December 2016.
  5. Cigna national book of business match case control analysis 2014-2015 Cigna Specialty Pharmacy Services vs. customers filling at retail.
  6. Cigna's nationwide Book of Business projected savings. January-September 2017. Reported on 11/1/17.
  7. Cigna National Book of Business pricing analysis 2017 - for Cigna formularies that use low net drug cost approach.
  8. 2016 National Book of business analysis of Regional segment clients with all benefits in place.

All statistics are for illustrative purposes only. Individual results may vary. Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, contact a Cigna representative. Group medical and pharmacy plans are insured and/or administered by Cigna Health and Life Insurance Company or its affiliates. Policy forms: OK - HP-APP-1 et al., OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al.