Specialty medications are used to treat chronic conditions like Crohn's disease, multiple sclerosis and rheumatoid arthritis. These medications are the fastest growing component of pharmacy plan costs-only 4% of customers take a specialty medication but they drive 28% of total health care costs.1
Applying traditional pharmacy benefit management principles is only part of the equation when it comes to managing specialty pharmacy. At Cigna, we take a connected approach across benefits to help deliver total cost management and better health outcomes.
How it Works
- Specialty medications are self-injected or taken orally and covered under the pharmacy benefit, or are infused or injected by a health care provider and covered under the medical benefit.
- Utilization management across benefits helps ensure customers and doctors choose the most clinically and cost efficient treatments, including where they get their drugs and where they are administered.
- Our formulary strategy determines the most affordable drug within a drug class and across the medical and pharmacy benefits.
- Integrated pharmacy and medical data show us the total health of our customers - including health conditions and diagnoses, the medications they take, and the doctors and facilities they use.
- Cigna conducts a prospective review of high cost injectable claims for specialty drugs like remicade®, neulasta® and intravenous immunoglobulin (IVIG). This verifies that customers start and continue therapy in a clinically appropriate and cost-effective site of care. Our site of care approach saved nearly $98.5M in one year for our clients, an average savings of about $109,000 per customer.2
- Cigna's provider relationships drive patients to lower-cost sites of care. We work with doctors to manage costs and create competitive discounts. Cigna manages drug costs for those covered under the medical benefit through aggressive doctor fee schedules. Cigna's 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. Currently Cigna is achieving -30% Average Wholesale Price (AWP) medical drug discount.3
- Cigna's specialty pharmacy offers specialty medications at competitive discounts. Through our collaborative relationships with providers, pharma manufacturers, pharmacies, and home health care providers, we are able to provide clients a degree of pricing predictability and quality control of medication distribution.
- Clinical and therapy management programs help provide customers with timely access to their medications and the support they need to achieve the best health outcome. Support and coaching programs are connected on one clinical platform across all benefits - medical, behavioral and disability - to help keep customers engaged and provide a better and more cohesive experience. In fact, when Cigna customers use our specialty pharmacy vs. using retail, they have over 7% higher medication adherence, 20% higher engagement and nearly 11% overall lower medical costs.4
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. Individual customer results will vary.
3Aggregate book of business discount of AWP -30% under the medical benefit achieved through the national injectable and immunization fee schedule (NIIFS). 2015.3. Cigna national book of business match case control analysis 2014-2015 Cigna Specialty Pharmacy Services vs. customers filling at retail.
4Cigna national book of business match case control analysis 2014-2015 Cigna Specialty Pharmacy Services vs. customers filling at retail.
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 Specialty 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.