Pharmacy Benefit Management

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Cigna Pharmacy Benefits

Dedicated to providing better engagement, better outcomes and value that goes beyond prescription drug coverage.

Connected Services to Reduce Costs

Choosing Cigna Pharmacy Management® as your Pharmacy Benefit Manager (PBM) means choosing a strategy to reduce total costs – pharmacy, Specialty Rx and medical.

Our enterprise connected clinical platform provides real-time access to customer insights across all benefits, and prioritizes opportunities. When a person with a known health need calls our pharmacy service, we can engage them in medical programs.

Formulary Strategy

A disciplined and active formulary strategy is an important strategic focus at Cigna: we help lower pharmacy claims costs by moving drugs with hyper-inflated costs and those with viable alternatives off formulary, regardless of pharmaceutical company incentives. We believe it’s the right action for our customers and clients.

Cost-Saving Benefit Options

Cigna Designed RxSM benefit packages are designed to give your employees convenience, protection and cost-effective options.

Basic Savings Package

$4.80 PMPM average2 annual pharmacy savings

Designed for clients who need less restrictive measures on access to drugs.

Balanced Savings Package

$8.20 PMPM average2 annual pharmacy savings

This is the package we recommend for most of our clients.

Max Savings Package

$9.40 PMPM average annual pharmacy savings2

Designed to generate maximized plan savings.

Each package includes certain supporting Cigna services:

Cigna 90 Now℠
A benefit and network for access and convenience

Cigna 90 Now includes two options that offer customers deep discounts for routine medication fills.

  • Mandatory requires customers to fill a 90-day supply of their routine medication at an in-network 90-day retail pharmacy or Cigna Home Delivery Pharmacy for coverage.
  • Voluntary allows customers to choose to fill a 30-day or a 90-day supply at an in-network retail pharmacy or Cigna Home Delivery PharmacySM for coverage.
Basic Savings Package Balanced Savings Package Max Savings Package
Voluntary Voluntary Mandatory
Drug Utilization Management
Helps protect from drug misuse (e.g., opioids)

With drug utilization management, certain medications are reviewed for safety and appropriateness.

  • Essential protection applies quantity limits, prior authorization and step therapy to certain drugs to help ensure safe prescribing, and coverage for the right medications and doses at a more affordable cost.
  • Complete protection offers the most protection by applying the same drug review protocols as Essential Protection, but to more drugs.
Basic Savings Package Balanced Savings Package Max Savings Package
Essential Protection Essential Protection Complete Protection
Cigna Specialty Pharmacy Services℠ (CSPS)
A personalized, integrated approach for those who need us most

CSPS offers an exclusive home delivery service for specialty medications. Customers get enhanced support, a result of full-benefit connectivity across pharmacy, medical, behavioral and disability.

  • First-fill customers must fill specialty medication prescriptions through CSPS, helping to avoid disruption.
  • Second-fill customers are allowed to fill their prescription once at a retail pharmacy, then are required to transition to CSPS for the second fill.
Basic Savings Package Balanced Savings Package Max Savings Package
Second fill at CSPS First fill at CSPS First fill at CSPS
Specialty drug supply
Support for better specialty medication adherence

Automatically provides customers with up to a 90-day supply of specialty medications with a prescription from the prescribing doctor.3 A standard 30-day supply of medications is available through CSPS.

  • 30-day drug supply provides customers access to a clinically appropriate quantity of specialty drugs. As a customer goes through therapy, a 30-day supply better manages potential waste and helps reduce related costs.
  • 90-day drug supply automatically covers up to a 90-day supply of specialty medications to customers with a prescription from their prescribing doctor.3 A standard 30-day supply of medications is available through CSPS.
Basic Savings Package Balanced Savings Package Max Savings Package
90-day supply 30-day supply 30-day supply
Generics
Drive increased generic use and reduced plan costs
  • Mandatory requires that a lower-cost, therapeutically equivalent generic drug must be used for coverage when available. When a customer or physician insists on a brand medication when a generic is available, the customer is responsible for paying the difference in cost plus the generic copay.
  • Promoted helps ensure customers use lower-cost, therapeutically equivalent generic drugs when available. If a brand-name drug is used, the customer pays the extra cost. With this program, the plan never pays more than the cost of the generic even when the customer chooses a brand-name drug.
Basic Savings Package Balanced Savings Package Max Savings Package
Not Included Promoted Mandatory
Formulary
A disciplined formulary strategy to reduce overall claim cost

Higher-cost drugs and/or those with viable alternatives are moved off formulary.

  • Value formulary is our most cost-effective prescription drug list. The Value formulary is the recommended approach for our clients who desire greater cost savings.
  • Standard formulary offers a foundation to remain competitive as a comprehensive formulary with a limited list of non-formulary brand drugs.
Basic Savings Package Balanced Savings Package Max Savings Package
Standard Formulary Value Formulary Value Formulary

Specialty Pharmacy Management

We apply a connected approach to specialty pharmacy across pharmacy and medical benefits. This consistent clinical strategy helps ensure that customers get the right therapy, at the right site of care, for the best price, and achieve the best health outcome.

Read more about our approach to specialty pharmacy management

Engaging Tools and Coaching Support

Our case managers and health coaches use real-time pharmacy insights and benefit and formulary information to help customers set health goals and join programs. These inter-connected programs provide holistic support, coordinating between medical and pharmacy benefits.

Offered at no additional cost with combined medical and pharmacy benefits:

  • Gaps in Care focuses on adherence issues and other gaps in care for customers with certain chronic conditions. It includes outreach by health coaches, case managers with nursing experience.
  • Drug Cost Tool on myCigna.com lets customers find real-time, personalized cost comparisons for prescription drugs and pharmacies.
  • The specialty condition therapy management program is a targeted drug therapy program for customers using specialty prescription drugs for certain chronic conditions. The program can help customers better understand their condition, medication side effects and the importance of adherence.

Offered with combined medical, pharmacy and behavioral health benefits:

  • Narcotic therapy management program sends reports to multiple prescribers for a patient who, based on prescribing patterns, may be at risk for opioid use disorder. We support the patient’s next best step, including behavioral coaching and case management. We do not send reports for customers with a cancer diagnosis or terminal illness.

More Included Services

  • Outcome-based contracting
  • Inflation protection
  • 180-day hold on new-to-market drugs
  • Compound non-FDA exclusion and enhanced prior authorization
  • National pharmacy network options

 

  • Retail audit and oversight
  • Site-of-care optimization for targeted specialty drugs covered under the medical benefit
  • Prior authorization for specialty drugs

Delivering Proven Value

A study conducted by a third party found that connected Cigna medical and pharmacy plans deliver on average $74 per member per year (PMPY) in medical cost savings (range of $60-88 PMPY).5

2017-value-connected-benefits-flyer-1-16x9-md
2017 Value of Connected Benefits [PDF]

This third-party study compared clients with Cigna medical and Cigna pharmacy to clients with Cigna medical only. The results proved that connected plans deliver savings, driven by customer engagement in health improvement programs.

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.

1Cigna national book of business pricing analysis, 2017.

22016 National Book of business analysis of Regional segment clients with all benefits in place. Individual client results will vary and savings are not guaranteed.

3Hepatitis C and oral oncology medications are limited to 30-day supplies, given the need for close monitoring to ensure therapy is effective and well tolerated, as there is a high rate of therapeutic interchange for oral chemotherapy medications due to side effect management.

4 These Cigna services offered at no additional cost, with combined medical and pharmacy benefits.

52017 Cigna national book of business study of medical customers who have Cigna pharmacy benefits vs. those with Cigna medical only. Average annual per member per year (PMPY) estimated medical savings of $74 ranges $60–$88. Average annual per member per year (PMPY) estimated medical savings of $253 ranges $175–$331 for those customers identified for health improvement opportunity – Specialty Rx and diabetes results for those who additionally engaged with case management or health coaching. Individual client/customer results will vary and are not guaranteed.

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 health plans are insured 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. “Cigna Home Delivery Pharmacy” refers to the specialty drug division of Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C., doing business as Cigna Home Delivery Pharmacy.