Specialty is the fastest growing area of pharmacy spend with only 4% of customers driving 28% of total health care costs.1
Specialty drugs are used to treat complex conditions like cancer, multiple sclerosis, and rheumatoid arthritis. They are self-injected, provider-infused, or taken orally and may be covered under the pharmacy or medical benefit - where it's the most difficult to manage.
Effective specialty drug management requires a coordinated approach. Our integrated pharmacy and medical platform provides insights on the total health of our customers - including conditions and diagnoses, medications, and doctor and facility use - allowing for real-time customer engagement for improved health and total cost management.
How we do it:
Specialty Formulary Management
Our formulary strategy determines the most affordable drug within a drug class and across both the medical and pharmacy benefits.
- Our Low Net Cost formulary strategy helps lower pharmacy claim costs by moving drugs with hyper-inflated costs and with viable alternatives off formulary, regardless of pharmaceutical company incentives.
Medical Pharmacy Management
With our integrated platform, we are able to see across both the medical and pharmacy benefit to ensure specialty drugs are being managed effectively.
- Site of Care Management - we conduct prospective drug reviews for high cost injectable claims for specialty drugs like remicade®, neulasta® and intravenous immunoglobulin (IVIG) to help ensure customers start and continue therapy in a clinically appropriate and cost-effective site of care.
- $98.5M estimated savings in one year for our clients, an average savings of about $109,000 per customer.2
- Provider Network Fee Schedules - we work closely with our provider network to manage costs and create competitive discounts. Our National Injectable and Immunization Fee Schedule (NIIFS) applies a fixed unit price based on industry standard methodology. We use the Average Sales Price (ASP) for a majority of medications and drug-level reimbursement.
- Achieving -30% Average Wholesale Price (AWP) medical drug discount.3
Utilization and Condition Management
Our specialized clinicians and integrated platform provide support to help our customers achieve the best health outcomes.
- Support and coaching programs are connected across all benefits - medical, behavioral and disability - to help keep customers engaged and provide a better and more cohesive experience
- Cigna customers using our specialty pharmacy vs. using retail realize:4
- 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 Program
Cigna Specialty Pharmacy
Through our collaborative relationships with providers, pharmaceutical manufacturers, pharmacies, and home health care providers, we are able to provide competitive discounts, pricing predictability, and quality control over costly specialty drugs.
- Exclusive Cigna Specialty Pharmacy customers receive enhanced support and full connectively across pharmacy, medical, and behavioral benefits
Cigna Specialty Pharmacy has earned full accreditation from URAC for its service, safety and improvement-oriented processes and programs.
1Cigna specialty medication users, integrated pharmacy and medical benefits claim review. Integrated Data Source January-December 2016.
2Cigna commercial business data January-October 2016. Cigna's nationwide book of business projected savings. January-September 2017. Reported on 11/1/17.
3Aggregate book of business discount of AWP -30% under the medical benefit achieved through the national injectable and immunization fee schedule (NIIFS). 2015.
4Cigna national book of business match case control analysis 2014-2015 Cigna Specialty Pharmacy Services vs. customers filling at retail.
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. Cigna Specialty Pharmacy refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C., doing business as Cigna Home Delivery Pharmacy. Policy forms: OK - HP-APP-1 et al., OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al.