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Cigna Pharmacy Benefits

Driving integrated value and improved care

Being a leader in today's dynamic pharmacy landscape requires innovation, coordination, and truly integrated holistic care that goes well beyond just managing drug unit costs. Customers need to be engaged in improving their health, data must be connected, and solutions must drive meaningful (bottom line) results.

  • $193 medical savings per member per year (PMPY) by integrating pharmacy with medical and behavioral, as proven by 2017 customer data. KPMG, global auditing and advisory firm, was engaged for review of study design and methodology.1
  • Lowest medical cost trend among our national competitors since 20102 and 0% commercial drug trend in 20173

How we do it:

Purposeful Engagement

Our shared clinical platform for medical, pharmacy, and behavioral provides actionable, real-time customer insights across all three benefits. This foundation of coordinated care and increased customer engagement allows for personalized coaching and effective condition and case management, including those taking a specialty medication.

  • $645 average medical savings PMPY for those with a health improvement opportunity1
    • 22% higher rates of engagement in condition and behavioral coaching
    • 15% higher completion of multiple activities in our medical health coaching and case management programs
    • $9,792 PMPY savings for engaged customers with a specialty condition1
    • $5,900 PMPY savings for engaged customers with diabetes1

Value-driven Solutions

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 because it delivers immediate savings and it also holds drug companies accountable for the pricing of their drugs. Learn more.

      • $47 per member per year (PMPY) savings with Cigna Formulary strategies4
      • Cigna 90 Now offers our pharmacy network’s deepest discounts and promotes 90-day fills for members taking medications on a daily basis
      • Cigna Designed Rx offers you easy options to create the optimal pharmacy benefit plan design for employees. These options include convenience, protection, and cost-effective solutions. Average annual savings realized per member per month (PMPM) include5:
        • $9.40 PMPM for Basic savings package
        • $8.20 PMPM for Balanced savings package
        • $4.80 PMPM for Max savings package
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 costs6. 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 Cigna pharmacy benefits 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 about our Total Specialty Drug Management

Cigna customers using Cigna Specialty Pharmacy vs. using retail realize7:

      • 7% or higher medication adherence
      • 20% higher engagement
      • 11% estimated overall lower medical costs
      • $109M estimated savings for 900 customers with our Site of Care Management Program8
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 installation, plan design, and action planning guidance and consultative reporting across medical, behavioral, and pharmacy
      • Real time benefit check connects a patient’s EMR/EHR with their pharmacy benefits, allowing the prescriber and patient to make informed decisions about prescriptions before the patient leaves the doctor’s office
      • Cigna Rx Claim Connect algorithm uses medical and Rx data to remove prior-authorization on select drugs/drug classes at the point of prescribing or at the point of service

Coordinated insights help drive employee engagement, improved outcomes, and cost savings.

Pharmacy Clinical Insight from Cigna

The Dose newsletter keeps you up-to-date on insights and updates from Cigna Pharmacy, including industry news and trends, drug recalls, formulary changes, and more. Read The Dose

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 2018 National Book of Business study of medical customers who have Cigna pharmacy benefits with behavioral benefits vs. those with Cigna medical and basic behavioral. Average annual per member per year (PMPY) – Individual client/customer results will vary and are not guaranteed.

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 Actual savings from 2016 – 2018 Q2 for clients on Standard/Performance and Value/Advantage formularies, uses average client pricing inclusive of both ingredient cost and rebate improvements, excludes global business.

5 Cigna specialty medication users, integrated pharmacy and medical benefits claim review. Integrated Data Source January-December 2016.

6 Cigna's nationwide Book of Business projected savings. January-September 2017. Reported on 11/1/17.

7 Cigna national Book of Business match case control analysis 2015 Cigna Specialty Pharmacy vs. customers filling at retail.

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.