Better health and savings through connected pharmacy benefit management (PBM)
Clients have concerns about rising drug costs and questions about complex pharmacy benefits.
Our approach to pharmacy benefits proactively identifies and connects medical health risks and pharmacy solutions. This approach goes beyond managing drug costs by taking advantage of the many customer touch points we get by connecting Cigna medical and pharmacy benefits.
There are four primary areas of focus and differentiation within Cigna's PBM. When viewed together, the features highlight our fully connected approach and help drive savings.
Holistic customer engagement
Our integrated engagement model identifies and prioritizes customers’ medical needs and gets them to the right condition and/or coaching program if needed. The opportunity to engage and influence a customer at the right time is lost when clients use an outside PBM. A recent third-party study compared overall medical costs of Cigna customers with both pharmacy and medical plans to those with only a Cigna medical plan. The study identified $74 PMPY medical savings for clients with Cigna medical and Cigna pharmacy. 1
Specialty pharmacy management
Drug costs under the pharmacy benefit are 33% of the total cost of a specialty medication.2 Focusing on just the drug is a missed opportunity. Our total-health strategy aligns key stakeholders, provides actionable insights, and engages customers and health care providers. Together, we can improve costs and help customers get the specialty medications and clinical support needed to improve their health.
Value-based contracts and formulary strategy
Our value-based contracts with network providers include performance metrics - with nearly 50% being tied to drug therapy. 3 We share actionable patient-specific information and ongoing communications to improve safety, health and costs for customers.
Negotiating a drug's unit cost and holding drug companies accountable for the performance of their medications (through outcome-based contracts) better assures that value is delivered versus volume.
We also apply a value-based approach to our formulary management. We carefully choose drugs for each drug class, finding those with the greatest value for our clients and customers, rather than including drugs based solely on manufacturer rebates.
Simplified service in a complicated environment. For clients, we provide plan design, implementation and reporting under one Cigna team. Our customers get easy-to-navigate tools and 24/7 customer service to help them better manage their health, medications and spending.
1Study by international consulting and accounting firm of 2017 Cigna national book of business. Results may vary.
2Cigna specialty medication users, integrated pharmacy and medical benefits claim review. Integrated Data Source January-December 2016
3Cigna National 2016 cost and quality metrics used to measure and reward doctors for patient outcomes within a Cigna Collaborative Care model.