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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 drives 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 program offers our pharmacy network’s deepest discounts and promotes 90-day fills for members taking medications on a daily basis
      • Cigna Designed Rx program 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
Specialty Drug Management and Clinical Care

Together with Accredo®, we are accelerating a combined model in specialty drug management. We are maintaining and advancing Cigna's focus in integrated care, customer touch points, utilization & wastage management, site of care optimization, and coordinated clinical care.

This foundation, combined with the individualized patient clinical management and scale from Accredo, will help deliver greater cost management and whole person care through expanded access; deep, experienced clinical teams knowledgeable in specific disease states; and a more personalized experience for our customers living with complex and costly conditions. Learn more about how we’re leading the way in in specialty drug management and clinical care.

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 inappropriate opioid use

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 evaluate whether coverage criteria are met 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 Cigna national book of business pricing analysis, 2017–2018 – for Cigna formularies that use low net drug cost approach. Drugs removed from Cigna Standard formulary. PMPY = Per Member Per Year. Actual results may vary.

5 2016 National Book of business analysis of Regional segment clients with all benefits in place. Individual client results will vary and savings are not guaranteed.

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 is a service mark 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.