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CIGNA Pharmacy Management Clinical Management

CIGNA Pharmacy Management CIGNA 900 Cottage Grove Road Hartford, CT 06152 www.CIGNA.com “CIGNA Pharmacy Management” is a registered service mark, and “Return On Health” is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. “CIGNA Pharmacy Management” refers to operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. © 2007 CIGNA Pharmacy Management. All rights reserved. 811485

Specialty Pharmacy Solutions Controlling specialty pharmacy costs and improving care to achieve a Return on Health SM


CIGNA Pharmacy Management: Delivering ROH through clinical integration

The biotech and injectable pipeline is rich with development. More than 300 new biotech drugs are expected to hit the market by 2010, 60% of which are for chronic conditions.1

Put CIGNA to work for your specialty pharmacy needs and get a Return On Health. To learn more about lowering your health trend contact your CIGNA Account Manager today, or visit www.CIGNA.com


CIGNA Benefit Design

Medication Examples

Why

Exclusive Pharmacy Coverage

MS: Avonex, Betaseron, Copaxone Hep C: Pegasys, Peg-Intron RA: Enbrel, Humira, Kineret Asthma: Xolair

• Self-administered • Retail available • Maximum discounts and member cost-share

Pharmacy & Medical Coverage

Erythropoetins: Procrit, Epogen, Neupogen Antiemetics: Kytril, Zofran Cystic Fibrosis: Garamycin

• Changing conditions and circumstances dictate the need for both

Hemophilia: Factor Autoimmune: I V I G RSV: Synagis

• Administered by a medical healthcare professional • Coordination of benefits when Medicare is the primary payer • Real-time assessment of both the need for and dosing of medications avoids unnecessary waste

Exclusive Medical Coverage

Flexible benefit management Our open access approach to specialty medication coverage allows for better clinical care Because specialty drugs are administered in a variety of settings, benefit coverage is of particular importance in making sure that those who need access to these drugs can get them with no hassles or delays. We classify injectable medications into three categories when establishing coverage: • Exclusive pharmacy coverage — We cover those specialty drugs that are suitable for self-injection exclusively under the pharmacy benefit. These medications are accessible through both the retail and the specialty pharmacy distribution channels. We thereby maximize ingredient cost discounts and member cost-sharing arrangements.

• Exclusive medical coverage — Some medications require careful dosing and administrative oversight by medical professionals. In these cases, the drugs may be safely administered only in a physician’s office, clinic or home setting with the assistance of a home-infusion nurse. We cover these medications exclusively under the medical benefit, with effective cost and clinical programs in place. • Pharmacy and medical coverage — The remainder of medications can fall into either of these two categories, depending on the member’s condition and circumstances. We cover these medications under both the medical and pharmacy benefit, allowing for timely access to medications without the confusion that results from restricted access. Effective cost and utilization management under both benefits and seamless claim handling drives member and physician satisfaction. Because costs are managed effectively regardless of the source of the drugs, employers can effectively cover specialty drugs in a way that makes sense from an access and administration perspective.

CIGNA Pharmacy Management: Delivering ROH through clinical integration

CIGNA Tel-Drug: Our multidisciplinary team of experts helps members with specialty drug needs CIGNA Tel-Drug offers a dedicated specialty pharmacy team made up of pharmacists and technicians who address all member needs relative to the use of specialty medications. The TelDrug specialty team partners with our health plans’ physicians and nurses to offer our members integrated case management services which can include the facilitation of the treating physician’s discharge plan and coordination of required specialty medications. CIGNA Tel-Drug offers:

Better access, better clinical management, greater Return On Health CIGNA’s integrated approach to managing specialty medications can help control your specialty pharmacy costs while improving member outcomes. Our industry-leading clinical capabilities allow us to go far beyond the adjudication and fulfillment of specialty medications to encompass where and how these medications are administered and the role they play in members’ overall therapy regimens. Better clinical management means less member confusion and disruption of care, better health outcomes and lower plan costs. In the end, that means a better Return On HealthSM.

• Extensive expertise and understanding of the needs of specialty pharmacy members. • Member-centric services, such as adherence management, pharmacist-to-member counseling, and 24/7/365 emergency pharmacist access. • Resources for newly diagnosed plan members who will require specialty medications, which can include a video, brochure and/or starter supplies.

The CIGNA approach to specialty medication management: CIGNA balances medication access with plan affordability to deliver a greater Return On HealthSM (ROH). Managing specialty medications is one of today’s biggest challenges for employers Studies show that a patient using a specialty treatment can cost a health plan as much as $1 million per year.2 As the specialty pharmacy market grows, plans need a way to offer members access to the specialty medications they require at the lowest possible cost to them and your plan. The CIGNA Specialty Pharmacy program offers employers, industry-leading clinical expertise, integrated cost-management strategies and personalized member-care management — an approach that balances medication access with plan affordability and quality outcomes.

6

Unlike stand-alone prescription benefit providers that manage specialty drug costs by placing restrictions on where medications can be accessed, CIGNA, as an integrated payer, allows members to access their medications in the most appropriate setting based on their unique circumstances. This means less member confusion and disruption in care, which in turn promotes medication adherence and healthier outcomes. We combine our established relationships with physicians, home healthcare providers, retail and specialty pharmacies and drug manufacturers with our comprehensive coverage and reimbursement policies, to offer members access to specialty medications at a lower net cost to your plan. Our goals are clear. CIGNA: • Achieves continuity in members’ care and promotes healthier outcomes through our case-management process.

• Resources for new and established members, including necessary materials and supplies at no additional cost. 3

The CIGNA Specialty Pharmacy solution: We ensure members have timely access to their specialty drugs in the most appropriate setting

• Provides member education and support through integrated clinical programs.

• Physician-centric services such as refill coordination of Synagis® at the physician practice level.

• Offers access to care and efficiency by not placing restrictions on where medications are accessed. • Ensures that medications are handled and shipped safely and efficiently through our specialty pharmacy network.

What does this mean to you? Our rational approach to managing specialty 1 2

3,5

4

Managed Health Care Executive, May 2007. “Specialty drugs to drive future health costs.” Benefit News.com. September 15, 2005. CIGNA Taking Charge of Specialty Pharmacy Costs Brochure, November 2006. Michelle Kirsche. “Drug Store News. Biotech prominence has drug reinventing its playbook.” http://findarticles.com/p/articles/mi_m3374/ is_10_27/ ai_n15341422/print.

Synagis is a registered trademark of Medimmune, Inc.

pharmacy balances outstanding member access to care with cost reduction strategies, to improve outcomes at a lower net cost. With CIGNA, your employees and their dependents will receive their specialty medications in the most appropriate setting. That means healthier member outcomes and a better Return On Health.

• Applies the prior authorization process consistently through a centralized and integrated team using clinical criteria founded on evidence-based medicine, so that members receive clinically appropriate medications according to their plan guidelines. • Achieves cost efficiency through innovative contracting strategies. Our holistic approach to specialty medication management balances both member and plan needs so that costs are managed, positive clinical outcomes are achieved and specialty medications are available and affordable.

1


Our Five Pillars of Specialty Pharmacy Management

What are specialty medications? Specialty medications are compounds that are used to treat complex and chronic medical conditions. These medications are typically high-cost drugs that are most often given by injection or infusion. Specialty medications can be self-administered but more often than not they are administered by a healthcare professional. Because specialty medications can require refrigeration or may have serious side effects, they often require special distribution methods and necessitate more comprehensive education. • Prices for biotech and injectable medications are growing at nearly double the rate of general pharmaceutical sales — about 20 percent from year to year.3 • 25 percent of prescriptions will be biotech by 20084 Specialty drug manufacturers spend many years and a substantial amount of money on the research, development and testing of these medications. Since specialty medications are used by approximately 1 percent of the population5, the demand for these drugs cannot support the development costs. As a result, specialty medications are priced at a premium so that manufacturers can recoup their investment costs. Although specialty medications are expensive, they are vital to the health and wellness of the members who need them to manage their unique conditions.

Our Specialty Pharmacy program uses a fivefold approach that balances your needs with those of your employees and their dependents. Since the majority of specialty medication costs naturally fall within the medical benefits plan, CIGNA is uniquely positioned to execute the five pillars as a result of its integrated clinical approach. Our five pillars of Specialty Pharmacy Management ensure that members have clinically appropriate access to their specialty medications at the lowest possible cost to your plan. The result is a specialty pharmacy management approach that supports a greater Return On Health.

cost/pat i ent

2

Mul ti ple Sc l erosis Rh eumatoid Arthritis Growth Hormone Deficiencies Hemoph i l i a / Bleeding disorders Hepatitis C + B

Total U.S. Market

#

affected

$34,000/yr $20,000/yr

$7 bi l l i o n $8 bi l l i o n

$30,000 – $40,000/yr $125,000/yr

$550 m i l l i o n

40,000

$ 3. 5 b i l l i o n

20,000

$1 65,000 / l i fet i me $1 0.7 b i l l i o n

The result: Members have timely access to their specialty medications without the confusion that would otherwise result from placing restrictions on how and where they can get theirspecialty drugs.

Our CIGNA Tel-Drug Specialty Pharmacy offers specialty medications at competitive discounts and the convenience of delivery to physicians and members. By integrating our distribution capabilities with our clinical programs, CIGNA Case Managers can ensure that members have timely access to their medications. The result: Members enjoy convenient home delivery of supplies and materials and 24/7 clinical support at no additional cost. Physicians can focus on treating the member’s condition as opposed to managing office inventories of medications and overseeing prior authorization and billing processes. Members and physicians experience timely order turnaround through CIGNA’s integrated utilization management and distribution process

4. Utilization management Our dedicated team of multidisciplinary professionals, including physicians, pharmacists and nurses, applies clinical criteria founded in evidence-based medicine standards across the medical and pharmacy benefit to determine medication necessity and when required confers with prescribing physicians about the clinical appropriateness of specialty medications for each member.

What does this mean to you? Chances are some of your employees or their dependents will be affected by these conditions. Without the right pharmacy plan in place, the cost to treat them can be higher than necessary. CIGNA gives you an opportunity to achieve the highest quality clinical outcomes at the lowest cost through highly integrated clinical programs and innovative contracting strategies.

Source: Special ty Pharmacy 2007 Stakeholders. Strate g i es and markets

The result: With no restrictions on distribution and access, physicians and members can be assured cost–effective access to care in the most appropriate setting.

3. Distribution

389,000 2. 5 m i l l i on

9–1 4 m i l l i o n

Our collaborative relationships with physicians, manufacturers, pharmacies and home healthcare providers offer employers a degree of pricing predictability and allow for quality control of medication distribution. Cost-management strategies are applied to all sources of distribution, and members are not restricted to any single distribution point. Our unique ability to integrate medical and pharmacy utilization reporting into a comprehensive reporting package provides plan sponsors with a holistic view of their specialty costs.

1. Coordinated benefit design We ensure that members have access to their medications in the most appropriate setting, without delay. We cover selfadministered injectable medications under the pharmacy benefit to maximize medication cost discounts through our network pharmacies. Medications that require administration by a medical professional are covered under the medical benefit. This ensures appropriate access to care in the most suitable setting and allows for the coordination of benefits with other primary payers such as Medicare.

Condi ti on

2. Unit-cost management

The result: By extending nationally applied clinical coverage policies to the pharmacy and medical benefit, we ensure consistency of coverage decisions as well as appropriateness of use and effectiveness of therapies. This, in turn, guarantees that the greatest value is achieved from the costs incurred.

5. Integrated case management The integration of members’ medical, pharmacy, lab and behavioral health data into our predictive modeling tool is just one of many ways we identify members at risk of incurring high claim costs. Members requiring assistance in managing their conditions are referred to and managed by skilled nurse case managers who are led by board certified physicians. The result: Our unique ability to integrate case management with the delivery and coordination of specialty medications improves medication adherence and promotes healthier member outcomes.

5


Our Five Pillars of Specialty Pharmacy Management

What are specialty medications? Specialty medications are compounds that are used to treat complex and chronic medical conditions. These medications are typically high-cost drugs that are most often given by injection or infusion. Specialty medications can be self-administered but more often than not they are administered by a healthcare professional. Because specialty medications can require refrigeration or may have serious side effects, they often require special distribution methods and necessitate more comprehensive education. • Prices for biotech and injectable medications are growing at nearly double the rate of general pharmaceutical sales — about 20 percent from year to year.3 • 25 percent of prescriptions will be biotech by 20084 Specialty drug manufacturers spend many years and a substantial amount of money on the research, development and testing of these medications. Since specialty medications are used by approximately 1 percent of the population5, the demand for these drugs cannot support the development costs. As a result, specialty medications are priced at a premium so that manufacturers can recoup their investment costs. Although specialty medications are expensive, they are vital to the health and wellness of the members who need them to manage their unique conditions.

Our Specialty Pharmacy program uses a fivefold approach that balances your needs with those of your employees and their dependents. Since the majority of specialty medication costs naturally fall within the medical benefits plan, CIGNA is uniquely positioned to execute the five pillars as a result of its integrated clinical approach. Our five pillars of Specialty Pharmacy Management ensure that members have clinically appropriate access to their specialty medications at the lowest possible cost to your plan. The result is a specialty pharmacy management approach that supports a greater Return On Health.

cost/pat i ent

2

Mul ti ple Sc l erosis Rh eumatoid Arthritis Growth Hormone Deficiencies Hemoph i l i a / Bleeding disorders Hepatitis C + B

Total U.S. Market

#

affected

$34,000/yr $20,000/yr

$7 bi l l i o n $8 bi l l i o n

$30,000 – $40,000/yr $125,000/yr

$550 m i l l i o n

40,000

$ 3. 5 b i l l i o n

20,000

$1 65,000 / l i fet i me $1 0.7 b i l l i o n

The result: Members have timely access to their specialty medications without the confusion that would otherwise result from placing restrictions on how and where they can get theirspecialty drugs.

Our CIGNA Tel-Drug Specialty Pharmacy offers specialty medications at competitive discounts and the convenience of delivery to physicians and members. By integrating our distribution capabilities with our clinical programs, CIGNA Case Managers can ensure that members have timely access to their medications. The result: Members enjoy convenient home delivery of supplies and materials and 24/7 clinical support at no additional cost. Physicians can focus on treating the member’s condition as opposed to managing office inventories of medications and overseeing prior authorization and billing processes. Members and physicians experience timely order turnaround through CIGNA’s integrated utilization management and distribution process

4. Utilization management Our dedicated team of multidisciplinary professionals, including physicians, pharmacists and nurses, applies clinical criteria founded in evidence-based medicine standards across the medical and pharmacy benefit to determine medication necessity and when required confers with prescribing physicians about the clinical appropriateness of specialty medications for each member.

What does this mean to you? Chances are some of your employees or their dependents will be affected by these conditions. Without the right pharmacy plan in place, the cost to treat them can be higher than necessary. CIGNA gives you an opportunity to achieve the highest quality clinical outcomes at the lowest cost through highly integrated clinical programs and innovative contracting strategies.

Source: Special ty Pharmacy 2007 Stakeholders. Strate g i es and markets

The result: With no restrictions on distribution and access, physicians and members can be assured cost–effective access to care in the most appropriate setting.

3. Distribution

389,000 2. 5 m i l l i on

9–1 4 m i l l i o n

Our collaborative relationships with physicians, manufacturers, pharmacies and home healthcare providers offer employers a degree of pricing predictability and allow for quality control of medication distribution. Cost-management strategies are applied to all sources of distribution, and members are not restricted to any single distribution point. Our unique ability to integrate medical and pharmacy utilization reporting into a comprehensive reporting package provides plan sponsors with a holistic view of their specialty costs.

1. Coordinated benefit design We ensure that members have access to their medications in the most appropriate setting, without delay. We cover selfadministered injectable medications under the pharmacy benefit to maximize medication cost discounts through our network pharmacies. Medications that require administration by a medical professional are covered under the medical benefit. This ensures appropriate access to care in the most suitable setting and allows for the coordination of benefits with other primary payers such as Medicare.

Condi ti on

2. Unit-cost management

The result: By extending nationally applied clinical coverage policies to the pharmacy and medical benefit, we ensure consistency of coverage decisions as well as appropriateness of use and effectiveness of therapies. This, in turn, guarantees that the greatest value is achieved from the costs incurred.

5. Integrated case management The integration of members’ medical, pharmacy, lab and behavioral health data into our predictive modeling tool is just one of many ways we identify members at risk of incurring high claim costs. Members requiring assistance in managing their conditions are referred to and managed by skilled nurse case managers who are led by board certified physicians. The result: Our unique ability to integrate case management with the delivery and coordination of specialty medications improves medication adherence and promotes healthier member outcomes.

5


Our Five Pillars of Specialty Pharmacy Management

What are specialty medications? Specialty medications are compounds that are used to treat complex and chronic medical conditions. These medications are typically high-cost drugs that are most often given by injection or infusion. Specialty medications can be self-administered but more often than not they are administered by a healthcare professional. Because specialty medications can require refrigeration or may have serious side effects, they often require special distribution methods and necessitate more comprehensive education. • Prices for biotech and injectable medications are growing at nearly double the rate of general pharmaceutical sales — about 20 percent from year to year.3 • 25 percent of prescriptions will be biotech by 20084 Specialty drug manufacturers spend many years and a substantial amount of money on the research, development and testing of these medications. Since specialty medications are used by approximately 1 percent of the population5, the demand for these drugs cannot support the development costs. As a result, specialty medications are priced at a premium so that manufacturers can recoup their investment costs. Although specialty medications are expensive, they are vital to the health and wellness of the members who need them to manage their unique conditions.

Our Specialty Pharmacy program uses a fivefold approach that balances your needs with those of your employees and their dependents. Since the majority of specialty medication costs naturally fall within the medical benefits plan, CIGNA is uniquely positioned to execute the five pillars as a result of its integrated clinical approach. Our five pillars of Specialty Pharmacy Management ensure that members have clinically appropriate access to their specialty medications at the lowest possible cost to your plan. The result is a specialty pharmacy management approach that supports a greater Return On Health.

cost/pat i ent

2

Mul ti ple Sc l erosis Rh eumatoid Arthritis Growth Hormone Deficiencies Hemoph i l i a / Bleeding disorders Hepatitis C + B

Total U.S. Market

#

affected

$34,000/yr $20,000/yr

$7 bi l l i o n $8 bi l l i o n

$30,000 – $40,000/yr $125,000/yr

$550 m i l l i o n

40,000

$ 3. 5 b i l l i o n

20,000

$1 65,000 / l i fet i me $1 0.7 b i l l i o n

The result: Members have timely access to their specialty medications without the confusion that would otherwise result from placing restrictions on how and where they can get theirspecialty drugs.

Our CIGNA Tel-Drug Specialty Pharmacy offers specialty medications at competitive discounts and the convenience of delivery to physicians and members. By integrating our distribution capabilities with our clinical programs, CIGNA Case Managers can ensure that members have timely access to their medications. The result: Members enjoy convenient home delivery of supplies and materials and 24/7 clinical support at no additional cost. Physicians can focus on treating the member’s condition as opposed to managing office inventories of medications and overseeing prior authorization and billing processes. Members and physicians experience timely order turnaround through CIGNA’s integrated utilization management and distribution process

4. Utilization management Our dedicated team of multidisciplinary professionals, including physicians, pharmacists and nurses, applies clinical criteria founded in evidence-based medicine standards across the medical and pharmacy benefit to determine medication necessity and when required confers with prescribing physicians about the clinical appropriateness of specialty medications for each member.

What does this mean to you? Chances are some of your employees or their dependents will be affected by these conditions. Without the right pharmacy plan in place, the cost to treat them can be higher than necessary. CIGNA gives you an opportunity to achieve the highest quality clinical outcomes at the lowest cost through highly integrated clinical programs and innovative contracting strategies.

Source: Special ty Pharmacy 2007 Stakeholders. Strate g i es and markets

The result: With no restrictions on distribution and access, physicians and members can be assured cost–effective access to care in the most appropriate setting.

3. Distribution

389,000 2. 5 m i l l i on

9–1 4 m i l l i o n

Our collaborative relationships with physicians, manufacturers, pharmacies and home healthcare providers offer employers a degree of pricing predictability and allow for quality control of medication distribution. Cost-management strategies are applied to all sources of distribution, and members are not restricted to any single distribution point. Our unique ability to integrate medical and pharmacy utilization reporting into a comprehensive reporting package provides plan sponsors with a holistic view of their specialty costs.

1. Coordinated benefit design We ensure that members have access to their medications in the most appropriate setting, without delay. We cover selfadministered injectable medications under the pharmacy benefit to maximize medication cost discounts through our network pharmacies. Medications that require administration by a medical professional are covered under the medical benefit. This ensures appropriate access to care in the most suitable setting and allows for the coordination of benefits with other primary payers such as Medicare.

Condi ti on

2. Unit-cost management

The result: By extending nationally applied clinical coverage policies to the pharmacy and medical benefit, we ensure consistency of coverage decisions as well as appropriateness of use and effectiveness of therapies. This, in turn, guarantees that the greatest value is achieved from the costs incurred.

5. Integrated case management The integration of members’ medical, pharmacy, lab and behavioral health data into our predictive modeling tool is just one of many ways we identify members at risk of incurring high claim costs. Members requiring assistance in managing their conditions are referred to and managed by skilled nurse case managers who are led by board certified physicians. The result: Our unique ability to integrate case management with the delivery and coordination of specialty medications improves medication adherence and promotes healthier member outcomes.

5


CIGNA Benefit Design

Medication Examples

Why

Exclusive Pharmacy Coverage

MS: Avonex, Betaseron, Copaxone Hep C: Pegasys, Peg-Intron RA: Enbrel, Humira, Kineret Asthma: Xolair

• Self-administered • Retail available • Maximum discounts and member cost-share

Pharmacy & Medical Coverage

Erythropoetins: Procrit, Epogen, Neupogen Antiemetics: Kytril, Zofran Cystic Fibrosis: Garamycin

• Changing conditions and circumstances dictate the need for both

Hemophilia: Factor Autoimmune: I V I G RSV: Synagis

• Administered by a medical healthcare professional • Coordination of benefits when Medicare is the primary payer • Real-time assessment of both the need for and dosing of medications avoids unnecessary waste

Exclusive Medical Coverage

Flexible benefit management Our open access approach to specialty medication coverage allows for better clinical care Because specialty drugs are administered in a variety of settings, benefit coverage is of particular importance in making sure that those who need access to these drugs can get them with no hassles or delays. We classify injectable medications into three categories when establishing coverage: • Exclusive pharmacy coverage — We cover those specialty drugs that are suitable for self-injection exclusively under the pharmacy benefit. These medications are accessible through both the retail and the specialty pharmacy distribution channels. We thereby maximize ingredient cost discounts and member cost-sharing arrangements.

• Exclusive medical coverage — Some medications require careful dosing and administrative oversight by medical professionals. In these cases, the drugs may be safely administered only in a physician’s office, clinic or home setting with the assistance of a home-infusion nurse. We cover these medications exclusively under the medical benefit, with effective cost and clinical programs in place. • Pharmacy and medical coverage — The remainder of medications can fall into either of these two categories, depending on the member’s condition and circumstances. We cover these medications under both the medical and pharmacy benefit, allowing for timely access to medications without the confusion that results from restricted access. Effective cost and utilization management under both benefits and seamless claim handling drives member and physician satisfaction. Because costs are managed effectively regardless of the source of the drugs, employers can effectively cover specialty drugs in a way that makes sense from an access and administration perspective.

CIGNA Pharmacy Management: Delivering ROH through clinical integration

CIGNA Tel-Drug: Our multidisciplinary team of experts helps members with specialty drug needs CIGNA Tel-Drug offers a dedicated specialty pharmacy team made up of pharmacists and technicians who address all member needs relative to the use of specialty medications. The TelDrug specialty team partners with our health plans’ physicians and nurses to offer our members integrated case management services which can include the facilitation of the treating physician’s discharge plan and coordination of required specialty medications. CIGNA Tel-Drug offers:

Better access, better clinical management, greater Return On Health CIGNA’s integrated approach to managing specialty medications can help control your specialty pharmacy costs while improving member outcomes. Our industry-leading clinical capabilities allow us to go far beyond the adjudication and fulfillment of specialty medications to encompass where and how these medications are administered and the role they play in members’ overall therapy regimens. Better clinical management means less member confusion and disruption of care, better health outcomes and lower plan costs. In the end, that means a better Return On HealthSM.

• Extensive expertise and understanding of the needs of specialty pharmacy members. • Member-centric services, such as adherence management, pharmacist-to-member counseling, and 24/7/365 emergency pharmacist access. • Resources for newly diagnosed plan members who will require specialty medications, which can include a video, brochure and/or starter supplies.

The CIGNA approach to specialty medication management: CIGNA balances medication access with plan affordability to deliver a greater Return On HealthSM (ROH). Managing specialty medications is one of today’s biggest challenges for employers Studies show that a patient using a specialty treatment can cost a health plan as much as $1 million per year.2 As the specialty pharmacy market grows, plans need a way to offer members access to the specialty medications they require at the lowest possible cost to them and your plan. The CIGNA Specialty Pharmacy program offers employers, industry-leading clinical expertise, integrated cost-management strategies and personalized member-care management — an approach that balances medication access with plan affordability and quality outcomes.

6

Unlike stand-alone prescription benefit providers that manage specialty drug costs by placing restrictions on where medications can be accessed, CIGNA, as an integrated payer, allows members to access their medications in the most appropriate setting based on their unique circumstances. This means less member confusion and disruption in care, which in turn promotes medication adherence and healthier outcomes. We combine our established relationships with physicians, home healthcare providers, retail and specialty pharmacies and drug manufacturers with our comprehensive coverage and reimbursement policies, to offer members access to specialty medications at a lower net cost to your plan. Our goals are clear. CIGNA: • Achieves continuity in members’ care and promotes healthier outcomes through our case-management process.

• Resources for new and established members, including necessary materials and supplies at no additional cost. 3

The CIGNA Specialty Pharmacy solution: We ensure members have timely access to their specialty drugs in the most appropriate setting

• Provides member education and support through integrated clinical programs.

• Physician-centric services such as refill coordination of Synagis® at the physician practice level.

• Offers access to care and efficiency by not placing restrictions on where medications are accessed. • Ensures that medications are handled and shipped safely and efficiently through our specialty pharmacy network.

What does this mean to you? Our rational approach to managing specialty 1 2

3,5

4

Managed Health Care Executive, May 2007. “Specialty drugs to drive future health costs.” Benefit News.com. September 15, 2005. CIGNA Taking Charge of Specialty Pharmacy Costs Brochure, November 2006. Michelle Kirsche. “Drug Store News. Biotech prominence has drug reinventing its playbook.” http://findarticles.com/p/articles/mi_m3374/ is_10_27/ ai_n15341422/print.

Synagis is a registered trademark of Medimmune, Inc.

pharmacy balances outstanding member access to care with cost reduction strategies, to improve outcomes at a lower net cost. With CIGNA, your employees and their dependents will receive their specialty medications in the most appropriate setting. That means healthier member outcomes and a better Return On Health.

• Applies the prior authorization process consistently through a centralized and integrated team using clinical criteria founded on evidence-based medicine, so that members receive clinically appropriate medications according to their plan guidelines. • Achieves cost efficiency through innovative contracting strategies. Our holistic approach to specialty medication management balances both member and plan needs so that costs are managed, positive clinical outcomes are achieved and specialty medications are available and affordable.

1


CIGNA Benefit Design

Medication Examples

Why

Exclusive Pharmacy Coverage

MS: Avonex, Betaseron, Copaxone Hep C: Pegasys, Peg-Intron RA: Enbrel, Humira, Kineret Asthma: Xolair

• Self-administered • Retail available • Maximum discounts and member cost-share

Pharmacy & Medical Coverage

Erythropoetins: Procrit, Epogen, Neupogen Antiemetics: Kytril, Zofran Cystic Fibrosis: Garamycin

• Changing conditions and circumstances dictate the need for both

Hemophilia: Factor Autoimmune: I V I G RSV: Synagis

• Administered by a medical healthcare professional • Coordination of benefits when Medicare is the primary payer • Real-time assessment of both the need for and dosing of medications avoids unnecessary waste

Exclusive Medical Coverage

Flexible benefit management Our open access approach to specialty medication coverage allows for better clinical care Because specialty drugs are administered in a variety of settings, benefit coverage is of particular importance in making sure that those who need access to these drugs can get them with no hassles or delays. We classify injectable medications into three categories when establishing coverage: • Exclusive pharmacy coverage — We cover those specialty drugs that are suitable for self-injection exclusively under the pharmacy benefit. These medications are accessible through both the retail and the specialty pharmacy distribution channels. We thereby maximize ingredient cost discounts and member cost-sharing arrangements.

• Exclusive medical coverage — Some medications require careful dosing and administrative oversight by medical professionals. In these cases, the drugs may be safely administered only in a physician’s office, clinic or home setting with the assistance of a home-infusion nurse. We cover these medications exclusively under the medical benefit, with effective cost and clinical programs in place. • Pharmacy and medical coverage — The remainder of medications can fall into either of these two categories, depending on the member’s condition and circumstances. We cover these medications under both the medical and pharmacy benefit, allowing for timely access to medications without the confusion that results from restricted access. Effective cost and utilization management under both benefits and seamless claim handling drives member and physician satisfaction. Because costs are managed effectively regardless of the source of the drugs, employers can effectively cover specialty drugs in a way that makes sense from an access and administration perspective.

CIGNA Pharmacy Management: Delivering ROH through clinical integration

CIGNA Tel-Drug: Our multidisciplinary team of experts helps members with specialty drug needs CIGNA Tel-Drug offers a dedicated specialty pharmacy team made up of pharmacists and technicians who address all member needs relative to the use of specialty medications. The TelDrug specialty team partners with our health plans’ physicians and nurses to offer our members integrated case management services which can include the facilitation of the treating physician’s discharge plan and coordination of required specialty medications. CIGNA Tel-Drug offers:

Better access, better clinical management, greater Return On Health CIGNA’s integrated approach to managing specialty medications can help control your specialty pharmacy costs while improving member outcomes. Our industry-leading clinical capabilities allow us to go far beyond the adjudication and fulfillment of specialty medications to encompass where and how these medications are administered and the role they play in members’ overall therapy regimens. Better clinical management means less member confusion and disruption of care, better health outcomes and lower plan costs. In the end, that means a better Return On HealthSM.

• Extensive expertise and understanding of the needs of specialty pharmacy members. • Member-centric services, such as adherence management, pharmacist-to-member counseling, and 24/7/365 emergency pharmacist access. • Resources for newly diagnosed plan members who will require specialty medications, which can include a video, brochure and/or starter supplies.

The CIGNA approach to specialty medication management: CIGNA balances medication access with plan affordability to deliver a greater Return On HealthSM (ROH). Managing specialty medications is one of today’s biggest challenges for employers Studies show that a patient using a specialty treatment can cost a health plan as much as $1 million per year.2 As the specialty pharmacy market grows, plans need a way to offer members access to the specialty medications they require at the lowest possible cost to them and your plan. The CIGNA Specialty Pharmacy program offers employers, industry-leading clinical expertise, integrated cost-management strategies and personalized member-care management — an approach that balances medication access with plan affordability and quality outcomes.

6

Unlike stand-alone prescription benefit providers that manage specialty drug costs by placing restrictions on where medications can be accessed, CIGNA, as an integrated payer, allows members to access their medications in the most appropriate setting based on their unique circumstances. This means less member confusion and disruption in care, which in turn promotes medication adherence and healthier outcomes. We combine our established relationships with physicians, home healthcare providers, retail and specialty pharmacies and drug manufacturers with our comprehensive coverage and reimbursement policies, to offer members access to specialty medications at a lower net cost to your plan. Our goals are clear. CIGNA: • Achieves continuity in members’ care and promotes healthier outcomes through our case-management process.

• Resources for new and established members, including necessary materials and supplies at no additional cost. 3

The CIGNA Specialty Pharmacy solution: We ensure members have timely access to their specialty drugs in the most appropriate setting

• Provides member education and support through integrated clinical programs.

• Physician-centric services such as refill coordination of Synagis® at the physician practice level.

• Offers access to care and efficiency by not placing restrictions on where medications are accessed. • Ensures that medications are handled and shipped safely and efficiently through our specialty pharmacy network.

What does this mean to you? Our rational approach to managing specialty 1 2

3,5

4

Managed Health Care Executive, May 2007. “Specialty drugs to drive future health costs.” Benefit News.com. September 15, 2005. CIGNA Taking Charge of Specialty Pharmacy Costs Brochure, November 2006. Michelle Kirsche. “Drug Store News. Biotech prominence has drug reinventing its playbook.” http://findarticles.com/p/articles/mi_m3374/ is_10_27/ ai_n15341422/print.

Synagis is a registered trademark of Medimmune, Inc.

pharmacy balances outstanding member access to care with cost reduction strategies, to improve outcomes at a lower net cost. With CIGNA, your employees and their dependents will receive their specialty medications in the most appropriate setting. That means healthier member outcomes and a better Return On Health.

• Applies the prior authorization process consistently through a centralized and integrated team using clinical criteria founded on evidence-based medicine, so that members receive clinically appropriate medications according to their plan guidelines. • Achieves cost efficiency through innovative contracting strategies. Our holistic approach to specialty medication management balances both member and plan needs so that costs are managed, positive clinical outcomes are achieved and specialty medications are available and affordable.

1


CIGNA Pharmacy Management: Delivering ROH through clinical integration

The biotech and injectable pipeline is rich with development. More than 300 new biotech drugs are expected to hit the market by 2010, 60% of which are for chronic conditions.1

Put CIGNA to work for your specialty pharmacy needs and get a Return On Health. To learn more about lowering your health trend contact your CIGNA Account Manager today, or visit www.CIGNA.com


CIGNA Pharmacy Management Clinical Management

CIGNA Pharmacy Management CIGNA 900 Cottage Grove Road Hartford, CT 06152 www.CIGNA.com “CIGNA Pharmacy Management” is a registered service mark, and “Return On Health” is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. “CIGNA Pharmacy Management” refers to operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. © 2007 CIGNA Pharmacy Management. All rights reserved. 811485

Specialty Pharmacy Solutions Controlling specialty pharmacy costs and improving care to achieve a Return on Health SM


Cost Management Programs

Fact Sheet

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CIGNA Pharmacy Management | Clinical Management

Step Therapy CIGNA’s distinctive Step Therapy program offers an approach that combines built-in flexibility for plan sponsors with sustained minimal disruption to plan members. For many chronic conditions, there are a number of prescription therapies available. In cases where conditions can be treated by several therapeutically equivalent medications, it makes sense to choose the medications that offer the greatest economic benefits to members and plan sponsors. With 70 drugs coming off patent within the next three years, plan sponsors need a way to seize the opportunities that clinically appropriate, lower-cost medication alternatives provide. With the right tool in place, plan sponsors can reduce costs for themselves and their members without compromising quality of care — and deliver a Return On HealthSM (ROH).

CIGNA has a solution Step Therapy is a CIGNA Clinical Cost Management program that promotes the use of generic drugs and lower-cost brand-name alternatives while at the same time, provides members and their physicians with the flexibility to use brand-name drugs when medically necessary. Our Step Therapy program focuses on conditions that traditionally account for a disproportionate percentage of your overall drug costs: Allergic Rhinitis, Hypertension, Stomach Acid and High Cholesterol. Since the drugs used to treat these conditions typically account for 16 percent of total pharmacy utilization and nearly one-quarter (23 percent) of total pharmacy costs1, Step Therapy can make a significant impact on your overall drug costs. By adopting CIGNA Step Therapy, plan sponsors increase utilization of generic alternatives, which helps lower costs for both members and employers. More importantly it can improve overall health trend, the cost of providing health-related benefits to employees by increasing member adherence to prescription therapy. Generally speaking, the more affordable medications are, the more likely members will adhere to their prescription therapies.

The Step Therapy Process

Unlike many other pharmacy benefit plans, CIGNA fills the first prescription, but also sends a personalized letter within a week to both member and physician.

A mailing instructs the member to contact the physician and discuss the feasibility of switching to a generic.

A mailing to the physician will suggest the use of a generic versus a brand-name drug, and provide a prior authorization request form in case the physician believes that the brand-name drug is the best therapeutic alternative.

If the physician wishes to continue prescription therapy with the brand-name drug, the physician can complete the prior authorization request form and submit it to CIGNA for approval.

If the member attempts to refill the prescription for a brand-name drug without prior authorization, the member will be denied and instructed to consult with the physician.

By making the Step Therapy process seamless for members and physicians, we promote member satisfaction.


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“For plan sponsors, CIGNA’s Step Therapy program has the potential to produce remarkable results with a possible average Return On Health of $2.00 per member per month (PMPM), the largest ROH of any CIGNA Pharmacy Management program.”2 — Thom Stambaugh, Chief Clinical Officer, CIGNA Pharmacy Management

Customize your plan with a variety of choices

Step Therapy: A win-win approach

CIGNA is one of only a few companies offering a Step Therapy program with inherent built-in flexibility for plan sponsors. With this innovative approach, variations can be selected based on the claims histories of members and their dependents to meet your objectives. These choices include the ability to select which drug classes to include, how to communicate the program to members, the grace period and the level of implementation. We also provide plan sponsors with an opportunity analysis that assesses their unique needs based on their utilization in each drug class and offer customized recommendations to help them build a Step Therapy program that’s right for them and their members.

When you implement CIGNA’s Step Therapy program and promote the use of generics and lower-cost brand-name drugs, both you and your members save money while maintaining quality healthcare. Once the program is implemented, members are more likely to adhere to their regimens, thus increasing the likelihood of improved outcomes. Healthier employees, combined with lower drug costs, mean a healthier bottom line for you.

Your ROH Calculator For plan sponsors, CIGNA’s Step Therapy program has the potential to produce remarkable results with a possible average Return On Health of $2.00 per member per month (PMPM), the largest ROH of any CIGNA Pharmacy Management program. Specifically, when you implement Step Therapy in the top therapeutic classes, you can expect to achieve the following savings:3

Choose — Drug Class (choose 1 or more)

■ ■ ■ ■

High Blood Pressure High Cholesterol Stomach Acid Allergic Rhinitis (Allergies)

• Blood Pressure — $0.41 PMPM • Cholesterol — $0.46 – $0.50 PMPM • Stomach Acid — $1.04 – $1.05 PMPM • Allergic Rhinitis — $0.05 PMPM

Choose — Implementation Method (can vary by drug class)

Flexible Choices That Matter

■ Initial Grace Period (30, 60, 90, 120) ■ First-Fill Pay & Education Process

Choose — Level of Management (can vary by drug class)

For more information

■ Generic First ■ Generic or Preferred Brand First ■ 2-Step ■ Stacked

CIGNA offers many programs that leverage integrated clinical data to educate and engage all stakeholders across the healthcare continuum. To learn more about how CIGNA can help you achieve a Return On HealthSM and deliver a high-quality, lower-cost pharmacy benefit to your employees and their dependents, contact your CIGNA Account Manager. 1 2 3

CIGNA Pharmacy Cost Summary Report CIGNA internal financial analysis Savings are estimated based upon an average and may vary by client.

CIGNA Pharmacy Management: Delivering ROH Through Clinical Integration

www.CIGNA.com “CIGNA Pharmacy Management” is a registered service mark, and “Return On Health” is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. “CIGNA Pharmacy Management” refers to operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. © 2007 CIGNA Pharmacy Management. All rights reserved. 811490


CIGNA Pharmacy Management Clinical Management

CIGNA Pharmacy Management CIGNA 900 Cottage Grove Road Hartford, CT 06152 www.CIGNA.com “CIGNA Pharmacy Management” is a registered service mark, and “Return On Health” is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. “CIGNA Pharmacy Management” refers to operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. © 2007 CIGNA Pharmacy Management. All rights reserved. 811483

Outcome Improvement Programs Closing gaps in care to improve outcomes and reduce costs for a Return On Health SM

To learn more about lowering your health trend, contact your C IG N A Account Manager today, or visit www.CIGNA.com . Put CIGNA to work for your outcome improvement needs and get a Return On Health .


CIGNA Pharmacy Management: Delivering ROH through clinical integration

THE COST OF UN-WELLNESS “Preventable illness makes up 90 percent of all healthcare costs.”1

Positive outcomes yield positive returns Are you ready to start getting a Return On HealthSM? For more than 200 years, the CIGNA name has been trusted by thousands of employers looking for better ways to protect the health of their most valuable resource, while at the same time finding solutions to rising healthcare costs. Our Outcome Improvement programs use a comprehensive approach to clinical care to do just that — bring positive health outcomes to your employees and their dependents and positive returns to your bottom line.

Health doesn’t just happen. Health requires information, action and improvement.

1 2

3

New England Journal of Medicine. July 29, 1993. DA Reiger, WE Narrow, DS Rae, et al. “The defacto US mental and addictive disorders service system: Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services.” Archives of General Psychiatry 1993;50:85-94. CIGNA Pharmacy Management case study information on file.


CIGNA Pharmacy Management: Delivering ROH through clinical integration

CIGNA’s integrated approach to pharmacy improves outcomes and avoids unnecessary medical costs, for a Return On Health (ROH)

CIGNA Outcome Improvement Programs: Engaging physicians to improve productivity and reduce costs

CIGNA provides a solution to the complex process of identifying and connecting gaps in healthcare — we call it our Outcome Improvement programs.

Where traditional pharmacy management programs end at managing drug trend — the cost of providing medications — CIGNA’s Outcome Improvement programs just begin. CIGNA combines broad access to pharmacy, medical, lab and hospital information with programs that anticipate potential health risks to provide physicians with a holistic view of members’ medical, behavioral and prescription histories. With this information, physicians can address gaps in care that are contributing to absenteeism and increased plan costs. By identifying pharmacy errors and omissions, fraud and the misuse and overuse of medications, CIGNA’s Outcome Improvement programs:

SM

As an employer, you need to strike a balance between providing attractive healthcare benefits to your employees and lowering your total healthcare costs. We call this balancing act managing your health trend — the year-to-year cost of providing all health-related benefits. When your health trend is on the rise, you’re not getting a positive return on the investment you’re making in your employees — and they’re not seeing a positive return on their health. Based on our industry-leading clinical expertise and access to comprehensive medical, pharmacy and lab data, our Outcome Improvement programs identify and correct gaps in care to promote healthier member outcomes. With CIGNA’s Outcome Improvement programs, you can maximize the value of your benefit by achieving optimal clinical outcome.

What does this mean to you? You have the potential to reduce your healthcare costs by taking steps toward preventing illness. CIGNA’s Outcome Improvement programs: • Integrate medical, behavioral and pharmacy benefits to improve the health of your employees; • Increase the use of generics to help make medications more affordable; and • Offer educational and incentive programs to encourage members to make better, more-informed choices. The result? A better Return On Health.

• Promote a more active physician-patient dialog; • Influence adherence to appropriate medications; • Reduce unnecessary drug costs associated with inappropriate utilization; and • Maximize the potential for positive health outcomes. CIGNA’s clinically focused Outcome Improvement programs transform comprehensive member information into useful tools for physicians so they can intervene and effect positive changes in their patients’ health. With the right tools and information, physicians are better equipped to manage their patients’ conditions. And when members are complying with the right treatment protocols, they are less likely to go to the hospital or experience unnecessary medical complications that impact their quality of life and increase total healthcare costs.

1


2

Narcotics Therapy Management Program: Identifying and addressing narcotic drug misuse with clinical support

Complex Psychiatric Case Management: Partnering with physicians to improve outcomes through information and action

Prescription drugs account for 25 to 35 percent of all drug abuse in the U.S.; and an estimated 31 million Americans have used painkillers without medical need.2 Misuse of controlled substances, especially narcotic prescriptions, along with mismanaged chronic pain, is associated with physical, social and psychological impairment. Those who misuse narcotic medications may have healthcare costs that are approximately 3 times higher than those who take their medications as prescribed.3 For employers trying to maintain a healthy and productive workforce, increased narcotic drug misuse poses a challenge. With CIGNA’s Narcotics Therapy Management program, employers can lessen the impact of narcotic drug costs on both plan costs and their employees’ health and wellness.

Members with underlying psychiatric conditions often experience related physical symptoms that prompt them to seek out their primary-care physician. In fact, research shows that as many as 24 percent of the patients who present themselves to primary-care physicians suffer from a mental disorder. As a first line of interaction with patients, primary-care physicians are in an ideal position to effect positive changes in patients coping with psychological conditions — changes that when addressed early can improve health outcomes and decrease related healthcare costs for members and their plan sponsors.

While some pharmacy management programs rely solely on prescription histories to determine if medication misuse or fraud exist, our program offers physicians comprehensive integrated clinical information to create a holistic view of members’ overall treatement. By combining medication, prescription, emergency room and hospital admissions information, CIGNA’s Narcotics Therapy Management program yields patient profiles that offer physicians the “big picture” of their patients’ current conditions and prescription use. To further support better coordination of care, our program also connects with CIGNA Well Aware Low Back Pain program if we see that the same member is participating in our disease management program. We also offer physicians additional patient management support tools through our website. Should there be a need to refer members for treatment of chemical dependency, our program helps coordinate such referrals for those members enrolled in CIGNA Behavioral Health. Fraud and abuse cases are funneled through a special investigation unit at CIGNA. By providing physicians with detailed member information and the right level of support, we give them the resources they need to effect positive changes in their patients’ narcotics therapy.

CIGNA’s Complex Psychiatric Case Management program is designed to provide physicians and psychiatrists with an integrated solution for patients taking multiple psychotropic drugs. With this information, physicians have a better picture of their patient’s prescription history and can determine the most appropriate treatment options. With the right treatment options, patients with psychiatric conditions can lead healthier and more productive lives and are less likely to suffer from complications and unnecessary hospitalizations due to poor medication adherence or suboptimal care. Fewer complications mean lower total healthcare costs in the long run — better for your employees and better for you. If members meet the program’s criteria, CIGNA sends their physicians a letter that provides an overview of the Complex Psychiatric Case Management program, along with a detailed profile of their patients’ six-month prescription histories. Complex Psychiatric Case Management also offers a peer-to-peer consultation service for primary-care physicians, giving them an opportunity to confer with experienced psychiatrists. If needed, we assist the physicians in offering their patients psychiatric referrals that can accelerate other psychological therapies to aid in their patients’ healing process, often reducing the number of drugs their patients take.


As Medication Adherence increases, overall medical costs decrease Ex: Diabetes $9,000

Annual Medical Spend $6,000 per employee

• • • • •

$3,000

1-19% 20-39% 40-59%

60-79% 80-100%

Compliance level

CIGNA Medication Adherence: Focused on improving adherence for more positive outcomes and a greater Return On Health No matter how comprehensive your company’s health plan is, your members won’t optimize their benefits — or their health — if they don’t take their medications properly. Even worse, when your members aren’t taking their medications as prescribed, they’re at a greater risk for missed work, increased hospitalizations and complications from suboptimal care. CIGNA uses pharmacy claims, lab results, physician office visits and in-patient admissions data to identify members who suffer from chronic conditions that have the greatest impact on your healthcare costs, such as diabetes and cholesterol. If CIGNA determines that these employees are not taking their medications as prescribed, we provide their physicians with profiles that list their medical and prescription histories. Armed with this information, physicians are able to have more informed conversations with their patients about the importance of adhering to their medication therapies. We also offer programs and tools to help members learn about their specific conditions, what medications are available under their plans and how they might be able to save money.

3


CIGNA Well Informed: Eliminating gaps in care to improve member outcomes A further enhancement of our current Outcome Improvement program is CIGNA Well Informed, a clinically based program that focuses on adherence issues and other gaps in care for members with specific chronic conditions where more disciplined medication therapy compliance can result in greater health benefits. These conditions include asthma, diabetes, back pain, high cholesterol and depression. By integrating pharmacy and medical data, CIGNA determines if members are adhering to their prescription therapy, filling prescriptions from multiple sources and receiving their required immunizations and screenings. We also compare their medical history with generally accepted standards of care. When gaps are identified, we communicate with members to guide them to appropriate action and provide their physicians with information so they can better support their patients. Depending on the severity of the gaps, we may also send patient-specific information to CIGNA Case Managers, pharmacists, chronic-disease clinicians and health advisors as part of CIGNA’s Health Advocacy Program. 4

What does this mean to you? Through early identification, proactive intervention and actionable information, CIGNA can help members avoid potential health risks, including unnecessary hospitalizations associated with medication noncompliance. In turn, we help employers avoid increased plan costs.


CIGNA Pharmacy Management: Delivering ROH through clinical integration

THE COST OF UN-WELLNESS “Preventable illness makes up 90 percent of all healthcare costs.”1

Positive outcomes yield positive returns Are you ready to start getting a Return On HealthSM?

1 2

3

New England Journal of Medicine. July 29, 1993. DA Reiger, WE Narrow, DS Rae, et al. “The defacto US mental and addictive disorders service system: Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services.” Archives of General Psychiatry 1993;50:85-94. CIGNA Pharmacy Management case study information on file.

For more than 200 years, the CIGNA name has been trusted by thousands of employers looking for better ways to protect the health of their most valuable resource, while at the same time finding solutions to rising healthcare costs. Our Outcome Improvement programs use a comprehensive approach to clinical care to do just that — bring positive health outcomes to your employees and their dependents and positive returns to your bottom line.

Health doesn’t just happen. Health requires information, action and improvement.

Put CIGNA to work for your outcome improvement needs and get a Return On Health . To learn more about lowering your health trend, contact your C IG N A Account Manager today, or visit www.CIGNA.com .


CIGNA Pharmacy Management Clinical Management

CIGNA Pharmacy Management CIGNA 900 Cottage Grove Road Hartford, CT 06152 www.CIGNA.com “CIGNA Pharmacy Management” is a registered service mark, and “Return On Health” is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. “CIGNA Pharmacy Management” refers to operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. © 2007 CIGNA Pharmacy Management. All rights reserved. 811483

Outcome Improvement Programs Closing gaps in care to improve outcomes and reduce costs for a Return On Health SM

To learn more about lowering your health trend, contact your C IG N A Account Manager today, or visit www.CIGNA.com . Put CIGNA to work for your outcome improvement needs and get a Return On Health .


Educate

Reduce costs

Improve Outcomes

Incent Encourage

CIGNA Pharmacy Management Clinical Management

CIGNA Pharmacy Management CIGNA 900 Cottage Grove Road Hartford, CT 06152 www.CIGNA.com “CIGNA Pharmacy Management” is a registered service mark, and “Return On Health” is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. “CIGNA Pharmacy Management” refers to operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. © 2007 CIGNA Pharmacy Management. All rights reserved. 811484

The CIGNA Difference to Cost Management SM

Changing behavior to deliver a Return On Health


CIGNA Pharmacy Management: Delivering ROH through clinical integration

“Most consumers want support and guidance from payers across all interactions.” — McKinsey on Health Care, March 2007


CIGNA Pharmacy Management: Delivering ROH through clinical integration

Member and physician behavior has a direct impact on your Return On Health . CIGNA Cost Management programs can help you influence behaviors to generate savings SM

CIGNA Clinical Cost Management programs motivate members and physicians to take actions that help reduce health trend—the year-over-year increase in your overall health costs. CIGNA engages and motivates members and their physicians to take positive steps in the treatment of acute, chronic and complex conditions. We offer programs that: • Educate members about potentially beneficial and cost-effective choices; • Provide incentives to make those choices; and • Encourage behaviors that lead to successful therapeutic and financial outcomes. The results for members and for you can be dramatic: • Our Cost Management programs generate an average Return On Health (ROH) of $2.25 to $2.30 per member per month (PMPM).1 • Our generic utilization rate ranks among the highest in the industry, with more than 60 percent of all prescriptions filled.2 • Our integrated approach results in savings of up to 50 percent of healthcare costs versus 15 percent with traditional pharmacy management alone.3

What does this mean to you? With cost management strategies grounded in a clinical context, CIGNA ensures that your employees and their dependents receive the medications they need at the lowest cost to your plan. With our flexible plan designs, we can help you customize a plan that balances member choice with cost-savings opportunities.

How do we do it? By employing cost reduction strategies with a clinical approach CIGNA boasts more clinicians than any other insurer. With their clinical expertise, we’ve developed programs such as Outcome Improvement and Specialty Pharmacy that help members and their physicians unlock the maximum potential value of medications. All of our programs are driven by a lowest-net-cost strategy that, when combined with our rigorous clinical evaluation process, reduces your overall health trend. Clinicians at all levels of our organization work together to: • Identify members at risk for serious medical conditions; • Provide those members with access to care; and • Ensure they maintain that care over time. Our clinical approach is what differentiates CIGNA in the pharmacy benefit plan marketplace. We believe we can make a major difference in the well-being of your employees and their dependents, as well as in the health of your bottom line.

1

CIGNA Tel-Drug: Delivering cost savings to members and employers CIGNA Tel-Drug, our state-of-the-art home delivery pharmacy, uses clinically based therapeutic interchanges to drive the use of the lowest-net-cost medications, while at the same time offering members convenient access to their medications. Through our ordering process: • New members whose employers have switched carriers can simply call our toll-free number and be assured that CIGNA Tel-Drug will contact their physicians for refill or renewal instructions. • Refill reminders are mailed automatically to members and renewal notices actually contain a prescription that members can bring to their physician for signature. • Refills, renewals and new prescriptions can be ordered online, by phone, fax or mail.


Cost Management Programs: A variety of tools to change and incent behavior — on your terms

Save With Generics: Promotes physician and member behavior changes to improve compliance and reduce costs

CIGNA Cost Management programs are categorized as educational, incentive or encouragement, and they offer flexibility based on your unique needs. Our programs allow you to choose which ones are right for your members and your plan goals, based on your desired approach and appetite for reducing overall healthcare costs.

When it comes to generic drugs, members and physicians need transparent information—they need to know that every drug on a formulary is there because it is clinically safe and effective, without regard to its cost or any available rebates. Over the past several years, nearly 70 medications have gone off patent, many of which were prescribed to treat the chronic conditions that account for the greatest percentage of drug spend. As a result, consumers now have generic alternatives available to them that can provide the same therapeutic benefits as their brand-name counterpart at a considerably lower cost.

By working closely with your CIGNA Clinical Account representative, you can determine which programs are appropriate for your plan, given your employee demographics and claims patterns.

2


CIGNA Pharmacy Management: Delivering ROH through clinical integration

CIGNA encourages members to explore these alternatives with their doctors to make the most cost-effective choices. Save with Generics targets both members and physicians with timely communications that alert them to the opportunity to prescribe generic alternatives. The program improves health trend in two important ways: • It encourages utilization of generics that offer the same therapeutic benefits as brand drugs at a considerably lower cost. • It improves compliance with prescription therapy by reducing cost, a major barrier to prescription adherence for many patients. The results for many CIGNA clients have been dramatic. Save with Generics generates an average Return On Health of $0.34 PMPM.4

OTC Programs: Incent members to try lower-cost, over-the-counter alternatives These incentive-based programs identify members with specific clinical conditions who might stand to benefit from Over-the-Counter (OTC) alternatives to the prescription drugs they’re taking. We send mailings to targeted members, along with money-saving coupons offering a substantial discount for trying OTC alternatives. The program currently focuses on acid reflux and allergic rhinitis, offering discounts for Prilosec OTC ® and Alavert ®.

What does this mean to you? Depending on your plan design and how quickly you want to realize savings, you can choose from programs that provide different levels of choice and flexibility.

Encouragement Programs: Rules-driven programs that strongly encourage more cost-effective actions For certain conditions, there is a wide variety of clinically appropriate therapeutic alternatives available. Our encouragement programs are based on one principle — if there is a group of therapeutically equivalent medications, why not encourage members and their prescribers to make the most cost-effective choice first? These programs account for the largest Return On Health of all Clinical Cost Management programs, with an average savings of $2.25 to $2.30 PMPM.5

Step Therapy Encourages the use of generics and lower-cost alternatives Step Therapy is a CIGNA Cost Management program that promotes the use of generic drugs and lower-cost brand-name alternatives while at the same time, provides members and their physicians with the flexibility to use brand-name drugs when medically necessary. CIGNA is one of the only companies offering a Step Therapy program with inherent built-in flexibilty for plan sponsors. With this innovative approach, variations can be selected based on the claims histories of members and their dependents to meet your objectives. These choices include the ability to select which drug class to include, the grace period and level of implementation. For plan sponsors CIGNA’s Step Therapy program has the potential to produce remarkable results with a possible Return On Health of $2.00 per member per month.6

3


Daily Dose Optimization Reduces costs for employees and employers when clinically appropriate What makes more sense, taking a 25-mg dosage of a prescription drug twice a day or a 50-mg dosage once a day? Generally, larger doses mean fewer pills, which can translate to lower costs for both members and their plan. Moreover, fewer pills mean fewer doses, which can increase members’ compliance with their prescription therapy and reduce the likelihood for gaps in care. Our Daily Dose Optimization program offers more cost-effective alternatives to prescribed dosages when deemed appropriate by our Pharmacy and Therapeutics Committee. Comprised primarily of outside clinicians, including leading physicians and pharmacists, the Committee bases its recommendations on FDA findings and other relevant information to determine which drugs are suitable for once-per-day dosing. Available as an option to self-insured plans, Daily Dose Optimization ensures the right dosage of the right medication and can result in more favorable outcomes from both a therapeutic and financial perspective.

Quantity Management Increases safety 4 Our Pharmacy and Therapeutics Committee also establishes policies that govern the allowable daily dosage amounts and the number of doses that can be dispensed within a prescription. These precautions are built into our claims process and result in greater safety with less possibility of negative effects from prescription overdose.

Member Communications: Educate, engage and empower employees to take positive action CIGNA proactively helps members understand their choices to help them — and your plan — save money. We do this through a variety of means, including: • MyCIGNA.com’s Price Comparison Tool • Direct mail on savings achieved by using Tel-Drug • Direct mail on savings achieved by generics (Save with Generics) • Outbound phone calls

Positive Outcomes Yield Positive Returns Are you ready to start getting a Return On HealthSM? For more than 200 years, the CIGNA name has been trusted by thousands of employers looking for better ways to protect the health of their most valuable resource, while at the same time finding solutions to rising healthcare costs. With our clinically based Cost Management programs, we help employers balance member choice with plan savings. In doing so, we promote positive member outcomes and a positive Return On HealthSM.

Utilization and Adherence The more your members correctly use and adhere to their prescription regimens, the more likely they are to achieve a healthier outcome

1, 8

Approximately 17 percent of all members don’t adhere to their prescription therapy because of cost.7 CIGNA Cost Management programs save members an average of $16 on a 30-day prescription while saving plan sponsors an average of $46.8 This can result in not only meaningful health-trend improvement, but greater likelihood that members will maintain or regain their health over time and not require more serious and costly medical treatment.

Alavert is a registered trademark of Wyeth Consumer Healthcare and Prilosec OTC is a registered trademark of Procter & Gamble.

2 3 4, 5 6 7

CIGNA Commercial Book of Business, as of 1/1/07. CIGNA Internal Competitive Research. CIGNA Commercial Book of Business, full year 2006. CIGNA Information on File. CIGNA Internal Financial Analysis. Boston Consulting Group analysis, Harris Interactive 10,000 Patients Survey, 2002.


CIGNA Pharmacy Management: Delivering ROH through clinical integration

“Most consumers want support and guidance from payers across all interactions.” — McKinsey on Health Care, March 2007


Educate

Reduce costs

Improve Outcomes

Incent Encourage

CIGNA Pharmacy Management Clinical Management

CIGNA Pharmacy Management CIGNA 900 Cottage Grove Road Hartford, CT 06152 www.CIGNA.com “CIGNA Pharmacy Management” is a registered service mark, and “Return On Health” is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. “CIGNA Pharmacy Management” refers to operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. © 2007 CIGNA Pharmacy Management. All rights reserved. 811484

The CIGNA Difference to Cost Management SM

Changing behavior to deliver a Return On Health


Outcome Improvement Programs

Fact Sheet

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CIGNA Pharmacy Management | Clinical Management

Complex Psychiatric Case Management Working with primary-care physicians to optimize medication, we improve health outcomes and reduce healthcare costs at the earliest opportunity to deliver a Return On HealthSM Members with an underlying psychiatric condition often experience related physical symptoms that prompt them to seek out their primary-care physician. In fact, research shows that as many as 24 percent of members visiting primary-care physicians suffer from a mental disorder.1 As a first line of interaction, primary-care physicians are in an ideal position to effect positive changes in members dealing with psychological conditions; however, lack of complete clinical information, resources and the correct level of support presents a huge challenge. CIGNA research has revealed 36 percent of mentalhealth inpatient admissions marked the first time members accessed their behavorial health benefits. By addressing these conditions early, health outcomes are improved and healthcare costs are decreased, delivering a Return On Health (ROH).

CIGNA has a solution CIGNA’s Complex Psychiatric Case Management program is designed to provide physicians and psychiatrists with an integrated solution for their patients who are taking multiple psychotropic drugs. With this information, physicians have a better picture of their patients’ prescription history and can determine the most appropriate treatment options. With the right treatment options, patients with psychiatric conditions can lead healthier and more productive lives and are less likely to suffer from complications and unnecessary hospitalizations due to poor medication adherence or suboptimal care. Fewer complications mean lower total healthcare costs in the long run, maximizing your Return On Health — better for your employees and better for you.

Helping physicians identify issues and effect change Because most health plans cover drugs that treat numerous psychiatric conditions with limited utilization management — and because there are so many different medications on the market to treat those conditions — there is a potential for overuse of the drugs used to treat psychiatric illnesses. CIGNA’s Complex Psychiatric Case Management works in conjunction with CIGNA Behavioral Health to optimize medication treatment regimens and decrease potential emergency room visits and mental-health related hospitalizations. Through this program we reach out to primary-care physicians and psychiatrists who have prescribed psychotropic medications to their patients and

provide them with specific information about their patients— which drugs they are taking and whether they are complying with their prescribed therapy based on their six-month prescription history. This program provides support to optimize the utilization of members’ pharmacy, behavioral health and medical benefits. With this information, physicians can have more informed conversations with their patients about their conditions and how they can better manage their own health.

Informing and supporting physicians to help improve care CIGNA’s Complex Psychiatric Case Management program looks at medications commonly used to manage a variety of psychiatric conditions, including the following classes of medications: • Antidepressants

• Benzodiazepine

• Stimulants

• Anxiolytics

• Sedative hypnotics

• Anticonvulsants

• Antipsychotics The program targets those members on a complex psychotropic medication regimen with potential for treatment optimization and care coordination. If a member fits the program’s criteria, CIGNA sends their physician a report that provides an overview of the Complex Psychiatric Case Management program, along with a detailed profile of the member’s six-month prescription history.


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According to a pilot study, CIGNA Complex Psychiatric Case Management program helps optimize therapy while reducing costs for employees enrolled in the program.2

Sample results for an employer using CIGNA’s Complex Psychiatric Therapy Management

Steps in Complex Psychiatric Management

• Member • PCP • Psychiatrist

Outreach

Referral Consult

Identification

4

Confirmation

Outreach

3

Pharmacy & Medical Data

2

1

Results

Health Advocacy & Clinical Tools • CBH specialist • Care Manager profile availability • Peer-to-Peer Consult • CIGNA Behavioral Health Integration • Medical Case Management

Complex Case Management Average savings • $3,500 per case per year Goal • Promote appropriate treatment by making the appropriate resources available

Action

Our provider reports also help physicians coordinate care with other healthcare providers, if necessary. Complex Psychiatric Case Management offers a Peer-to-Peer consultation service for primary-care physicians, giving them an opportunity to discuss patient histories with experienced psychiatrists. If needed, we assist the physicians in offering their patients psychiatric referrals that can accelerate other psychological therapies to aid in their patients’ healing process, which further optimizes treatment for the patient. In addition, communications are sent to program members educating them on their behavioral health benefit and encouraging its use. This ensures that members are offered the appropriate level of care to meet their needs.

Promoting healthier outcomes for a greater Return On Health

This employer realized a 57 percent shift in care from a primary-care physician (PCP) to a psychiatrist, which resulted in a 30 percent reduction in medical and pharmacy costs.2

* Savings may vary on a case–by–case basis.

to reduce plan costs and create better health outcomes for your employees. When your employees are taking their medications as prescribed, they are less likely to experience adverse reactions from medication overuse and misuse. This means a healthier and more productive workforce and a better Return On Health.

For more information CIGNA offers many programs that leverage integrated clinical data to educate and engage all stakeholders across the healthcare continuum. To learn more about how CIGNA can help you achieve a Return On HealthSM and deliver a high-quality, lower-cost pharmacy benefit to your employees and their dependents, contact your CIGNA Account Manager. 1 2

By working in conjunction with CIGNA Behavioral Health, Complex Psychiatric Case Management leverages the breadth and depth of our clinical expertise and information

5

Mental Disorder in Primary Care: Program Guide WHO/MSA/MNHIEAC/98.1. Data on File, CIGNA Pharmacy Management, 2006

CIGNA Pharmacy Management: Delivering ROH Through Clinical Integration

www.CIGNA.com “CIGNA Pharmacy Management” is a registered service mark, and “Return On Health” is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. “CIGNA Pharmacy Management” refers to operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. © 2007 CIGNA Pharmacy Management. All rights reserved. 811487


CIGNA Pharmacy Management

CIGNA Pharmacy Management CIGNA 900 Cottage Grove Road Hartford, CT 06152 www.CIGNA.com “CIGNA Pharmacy Management” is a registered service mark, and “Return On Health” is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. “CIGNA Pharmacy Management” refers to operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. © 2007 CIGNA Pharmacy Management. All rights reserved. 811482

The Clinical Difference Delivering Return On HealthSM Through Clinical Integration


Health insurance expenses are the fastest growing cost component for employers. Unless something changes dramatically, health insurance costs could overtake profits by 2008. Source: McKinsey and Company

PUT CIGNA TO WORK FOR YOU Are you ready to start getting a Return On Health ? To learn more about lowering your health trend, contact your CIGNA Account Representative today, or visit www.CIGNA.com.


CIGNA Pharmacy Management: Delivering ROH Through Clinical Integration

The statistics are staggering…

A convincing formula

. . . Employer health insurance premiums increased by approximately twice the rate of inflation last year and show no signs of letting up.2

CIGNA Pharmacy Management can reduce overall health trend by as much as 50 percent when integrated with CIGNA HealthCare.3

However, companies are finding relief from this problem by focusing on one component of their overall health benefit spend — their pharmacy benefit plan.

CIGNA is leading the way by improving health trend. By focusing on the total health of your employees and how they use their prescription drugs, CIGNA can reduce your total health costs. It’s a solution that’s far more effective than simply managing drug trend. It’s an integrated approach that we call managing health trend — the annual cost of providing all health-related benefits. What makes CIGNA unique is our depth and breadth of clinical expertise and focus. With more clinicians on staff than any other health insurer, our clinical approach improves patient outcomes to avoid high-cost medical treatments such as emergency room visits and hospital stays. Undoubtedly, the integration of medical and pharmacy benefits achieves an ROI. But CIGNA’s holistic clinical approach elevates it to what we call giving our clients a Return On HealthSM (ROH).

What does this mean to you? By integrating clinical programs and case management across medical and pharmacy and implementing effective cost-management programs, CIGNA improves clinical outcomes that lower your overall healthcare costs and generate a greater Return On Health.

The key word is “integrated.” By itself, CIGNA can reduce your drug trend by 5-10 percent versus other pharmacy benefit plans.4 Through integrated case management, clinical programs and access to medical, behavioral and dental programs, CIGNA can increase the likelihood that employees: • Receive the right medications at the right time; • Avoid unfavorable drug interactions and side effects; and • Adhere to their therapy as prescribed. Moreover, we can identify employees at risk for more serious conditions, help them obtain the care they need and improve their compliance with that care over time.

The Clinical Difference Best-in-class clinical offering that achieves results CIGNA engages and motivates members to take active steps in the treatment of acute, chronic and complex conditions — steps that can lead to healthier outcomes and lower costs for them and their employers. At the same time, we empower physicians to make decisions based on a more holistic view of their patients’ conditions than would otherwise be available to them. The key to our ability is our on-staff clinical expertise. CIGNA has more clinicians than any other health insurer.5 More clinicians mean a stronger emphasis on holistic healthcare. Doctors, nurses, pharmacists — these professionals formulate and implement policy at our most senior levels. And they all work together to develop integrated programs that: • Educate members about potentially beneficial and cost-efficient choices (for example, web tools); • Provide incentives to make those choices (for example, coupon programs); and • Encourage behaviors that lead to successful outcomes from both therapeutic and financial perspectives (for example, Step Therapy).

1


Outcome Improvement Programs: More than data — changing behavior to improve outcomes and avoid unnecessary medical costs Americans are aging and taking more medications than ever before. Furthermore, they have more medications to choose from, with brand-name drugs, generics and therapeutic alternatives proliferating in the marketplace and drug companies marketing them directly to consumers.

2

CIGNA’s clinical programs can help employees avoid unfavorable drug interactions and side effects that can lead to increased medical expense and even hospitalization. By identifying gaps in care, our clinical programs help employees adhere to their prescription regimens to improve their overall results, stay healthy and avoid additional medical and pharmacy costs. As their name implies, these Outcome Improvement programs are designed to help members treat conditions with greater safety, efficacy and cost-efficiency.

Well Informed Program Eliminates gaps in care across all member touchpoints A recent study quantified what many plan sponsors have known all along. Prescription nonadherence costs employers approximately $177 billion annually in preventable services and lost productivity.6 And only about 8 percent of United States consumers are aware that their own nonadherence is an issue.7


CIGNA Pharmacy Management: Delivering ROH Through Clinical Integration

CIGNA’s Well Informed program focuses on the adherence issue and other gaps in care that can negatively affect desired outcomes and even exacerbate medical conditions. Well Informed focuses on the chronic conditions most likely to benefit from disciplined prescription therapy. These include asthma, diabetes, back pain and high cholesterol. Through clinical programs and case management, we determine whether members are adhering to prescriptions, filling prescriptions from multiple sources and receiving immunizations and screenings. We also compare their history to evidence-based medical standards of care. When a gap in care occurs, we communicate with both the members and their physicians to: • Guide members to appropriate action; and • Alert the physician with information he or she needs to make decisions and communicate with patients. Well Informed examines members’ integrated pharmacy, medical and other healthcare data on a monthly basis. The information it creates is timely and actionable. And depending on the nature and severity of the gap, information is transmitted to CIGNA Case Managers, pharmacists, chronic disease clinicians and health advisors as a part of CIGNA’s Health Advocacy programs. CIGNA knows that healthy employees are the backbone of a healthy business. Through our clinical programs that address medication adherence, we help your employees achieve healthier outcomes so they can remain the valuable resources your business relies on.

What does this mean to you? CIGNA’s clinical management can improve member outcomes by identifying gaps in care and addressing adherence issues. By leveraging medical and pharmacy data through proactive case management, CIGNA equips physicians, pharmacists and members with the information and on-going personal support they need to take positive actions toward improving members’ health and reducing overall healthcare costs.

Complex Psychiatric Case Management Program Reduces expensive medical costs and increases productivity For too many employers, the problem is becoming all too familiar — increased absenteeism and decreased productivity because of employees with depression, anxiety and other behavioral disorders. In addition, these employees often account for the top 10 percent of employer medical expenditure8, with frequent emergency room visits and multiple psychotropic drug prescriptions prescribed too often by multiple physicians. CIGNA’s Complex Psychiatric Case Managment program is offered as an option with CIGNA Behavioral Health. It identifies employees who fill psychotropic drug prescriptions beyond specific thresholds and alerts their primary-care physicians or psychiatrists with personalized patient profiles. Physicians then have the information they need to consult with their patients and coordinate care with other healthcare providers, if necessary. In addition, our Peer-to-Peer Counseling Service offers primary-care physicians the opportunity to consult with experienced psychiatrists for psychiatric referrals to help accelerate the healing process.

Narcotics Therapy Management Program Identifies potential misuse and fraud Healthcare costs for narcotics abuse are three times those for non-abusers. And with prescription drugs accounting for 25-30 percent9 of all drug abuse in the United States, CIGNA developed its Narcotics Therapy Management program to identify potential abusers and empower their physicians to pursue the most effective courses of therapeutic action. The program focuses on narcotic analgesics, a leading prescription expense for many of our members. It integrates CIGNA medical and pharmacy data to identify possible abusers and fraud perpetrators. Then CIGNA reaches out to prescribing physicians with information that provides them with evidence and resources to engage members in productive dialogues.

3


Cost Management Programs: Key driver to lowest net cost CIGNA’s Cost Management programs generate a generic dispensing rate that ranks among the highest in the industry, at approximately 60 percent. They provide total PMPM savings that range from $2.25 to $2.30.10 However, when it comes to the interplay between member choice and employer cost, different plan sponsors have different points of view. No sponsor, however, wants to compromise quality of care in the interest of savings. That’s why CIGNA’s Cost Management programs are developed with the same clinical expertise that distinguishes our Outcome Improvement programs.

Save with Generics Lets you capture savings from a $46 billion opportunity occasioned by brand-name drugs coming off patent by 201011 Never has there been a greater opportunity than now to lower prescription drug costs than by encouraging the use of generic drugs among your employees. CIGNA educates, engages and incents members and physicians to try generics and preferred brands. With one of the highest generics utilization rates in the industry, CIGNA has proven its ability to lower your costs while maintaining high member satisfaction. Outreach programs include: • Physician: CIGNA targets physicians to show them how much their patients would save by using generic therapeutic alternatives and encourages them to write prescriptions for alternatives, when appropriate. • Member: Within one month after he has filled a brand-name prescription, CIGNA corresponds with the member to educate him about generics and urge him to discuss these lower-cost alternatives with his physician.

4


CIGNA Tel-Drug: Delivers cost OTC Programs Incents members to try lower-cost, over-the-counter alternatives Over-the-counter (OTC) programs identify members who stand to benefit from OTC alternatives to prescription drugs and offer them money-saving coupons for trying alternatives. Currently, programs are available for Prilosec OTC® and Alavert®.

Step Therapy Program Gradually encourages use of generics and lower-cost alternatives CIGNA’s Step Therapy program gradually encourages the use of generics in a way that reduces member disruption. The program begins when a member requests a prescription for a brand-name drug that has generic therapeutic alternatives. Unlike many other pharmacy benefit plans, CIGNA fills the first prescription with a brand name if prescribed. Correspondence is sent to members and physicians about refilling with generics. Physicians are given the opportunity to authorize a brand drug if necessary. By offering members an initial grace period and the ability to fill a prescription for a brand-name drug and then educating them on the merits of generics, members are given ample time to transition to clinically-appropriate, lower-cost alternatives.

savings for members and clients

1) Employers save

Members save

Increased GDR

larger days’ supply

2) Increased adherence

through refill reminders and pharmacist consultations

3) Improved accuracy is 99.995% through automation

For healthier outcomes at an even lower cost…

Currently, CIGNA offers Step Therapy for anti-ulcer, hypertension, high cholesterol and allergic rhinitis medications.

. . . call CIGNA Tel-Drug, our state-of-the-art home delivery prescription drug program. With two locations (Pennsylvania and South Dakota), Tel-Drug provides fast, efficient service.

What does this mean to you?

Tel-Drug typically saves members the equivalent of a co-pay by ordering a 90-day supply of medication versus three refills at a local pharmacy. Refills are processed the same day they’re ordered. And accuracy is an astounding 99.995 percent, far higher than that of any retail pharmacy.

Cost Management programs don’t have to limit member choices. Our education-based programs provide members and their doctors with the information they need to determine whether they should fill brand-name prescriptions with generic therapeutic alternatives. We’re proud of the fact that we’ve helped members adhere to their therapy through equally effective, lower-cost options. And we’re equally proud that we’re helping plan sponsors reduce health trend while maintaining member choice.

Almost 30 percent of all CIGNA prescriptions are filled through Tel-Drug; and, increasingly, many of them are for generic alternatives, thanks to Tel-Drug’s education outreach programs that alert members about less costly but equally effective options to their brand-name medications.

5


CIGNA Specialty Pharmacy: Balancing medication access to to deliver a Return On Health Specialty pharmacy is the fastest growth area of pharmacy healthcare. The Compound Annual Growth Rate for the 2003-2008 period is estimated to be 20 percent, with the 2008 CAGR forecasted to be $78 billion.12 The high cost of specialty drugs is becoming an issue for employers who are faced with per-patient costs potentially reaching $1 million annually.13 With a major increase expected in the number of biotech medications available and an aging population, total specialty drug costs could rise considerably higher. CIGNA’s Specialty Pharmacy solutions balance your needs with those of your employees and their dependents so that costs are managed, access to specialty medications is made affordable and positive therapy outcomes are maximized.

6

CIGNA’s integrated approach to managing specialty medications can help control your specialty pharmacy costs while improving member outcomes. Through integrated case management, CIGNA consolidates members’ medical, pharmacy, lab and behavioral healthcare to help members at risk of incurring high claims costs better manage their conditions. This ability to integrate case management with the delivery and coordination of specialty medications in real time allows clinical experts and trained support professionals to help improve medication adherence and promote healthier member outcomes. Our industry-leading clinical capabilities allow us to go far beyond the adjudication and fulfillment of specialty medications to encompass how these medications are administered and the role they play in members’ overall therapy regimens. Better therapy management means less confusion and disruption of care, better health outcomes and lower plan costs. In the end, that means a better Return On Health.

CIGNA Pharmacy’s Financial Management and Service Model: Starts with a complete analysis of opportunities, behaviors and goals CIGNA offers numerous programs and cost structures from which you can design your pharmacy management plan. The question is which combination of benefits and pricing offers the optimal solution for your business. CIGNA provides the right balance of quality care while lowering health trend. Just as CIGNA provides members with the educational tools they need to make informed decisions, we offer plan sponsors the ability to understand current employee behaviors and structure their plans to accommodate those behaviors and perhaps change them over time. For example, what’s your current employee generic utilization rate? Your formulary compliance rate? How much is your plan spending on the chronic conditions that typically constitute more than 50 percent of drug spend — asthma, depression and high cholesterol, to name but a few? By understanding your employee claim patterns and demographics, you can design a plan that offers the maximum opportunity for improved employee health at the lowest net cost. And you can weigh this information against the cost and employee choice variables that run the flexibility spectrum from self-insured plans and step therapy to the variety of integrated health outcome programs discussed earlier.

What does this mean to you? One design does not fit all plans. We analyze your employee demographics and claims history before recommending a design specifically structured to address the conditions most likely to influence your overall health trend. As one of America’s oldest and most respected insurance companies, CIGNA understands risk. What’s more, we help you minimize your risk by maximizing your Return On Health potential.


CIGNA Pharmacy Management: Delivering ROH Through Clinical Integration

Whatever choices you make, however, you can be certain that CIGNA provides you with:

Total Transparency From a partner you can trust CIGNA welcomes the move toward transparency. Our approach has always been to maximize savings for clients and members while providing the most clinically appropriate drugs for members. Through aggressive contracting strategies, member and physician education and incentive programs, and clinical management, CIGNA provides a fully transparent approach to managing pharmacy benefits that you can count on. CIGNA’s Pharmacy and Therapeutics Committee is charged with analyzing new drugs to determine their safety and efficacy versus other alternatives. The Committee is comprised primarily of leading physicians and pharmacists and focuses solely on clinical concerns when issuing its recommendations.

Our formulary practices are representative of our commitment to transparency in everything we do. That means an approach to client and member savings that does not rely on rebates. We are proud of the certification of transparency we have received from the Human Resources Policy Association, an organization comprised of senior human resource executives representing nearly every major industry group in the United States economy.

Comprehensive Service Empowers you to measure your ROH Your CIGNA Pharmacy Clinical Account Manager is dedicated to helping you define objectives for your plan, design it accordingly and track your progress over time. In fact, the vast majority of our Account Managers are licensed pharmacists with an extensive background in benefits management and a keen understanding of how pharmacy benefits can be used to improve member health outcomes and decrease client cost.

7


You can depend on your Account Manager to help you evaluate CIGNA’s quarterly and annual performance reports that provide in-depth views of plan activities. You’ll gain important insights on: • What’s really driving your plan’s cost; • Which therapeutic conditions demand special focus; and

We think you should consider a plan that does.

• Where the opportunities to optimize utilization and adherence may be found.

Return On Health = CIGNA Pharmacy Management

The technology behind our reporting function is designed to capture and analyze the rich data available from our integrated approach to improving health trend. We combine pharmacy data with lab results, diagnoses, emergency room visits and other medical information to provide you with a total portrait of where you stand and what you have to do to achieve your members’ health and cost objectives.

8

Is your current pharmacy benefit plan generating a Return On Health?

It’s a powerful formula that can be quantified. And as you would expect, it’s a formula that we can substantiate. With roots that go back to 1792, CIGNA is one of America’s oldest and most respected employee benefit plan providers. Our heritage is insurance and our ability to manage risk prudently serves our clients well.

Member Communications that Educate, Engage and Empower

Because CIGNA assumes much of the risk inherent in pharmacy management and other healthcare plans, we are acutely aware of the need to minimize your risk as much as possible.

CIGNA’s clinical programs all feature extensive member outreach components that engage members at specific trigger points and motivate them to take positive action. Central to our member communications efforts is myCIGNA.com, our secure member website that offers a wide variety of online tools to facilitate member decisions.

In an industry that sometimes produces commoditized programs, CIGNA stands out with its clinical focus and unique approach to controlling health trend. For more information, contact your CIGNA representative and find out how you can achieve a higher Return On HealthSM for your employees and your business.

myCIGNA.com provides members with access to their personal claims history, as well as an overview of the benefits to which their plan entitles them. Our Prescription Drug Price Comparison Tool enables members to: • Search for specific drugs and price them out at Tel-Drug or any of the more than 57,000 retail pharmacies in CIGNA’s nationwide network; • Order prescriptions and refills directly from CIGNA Tel-Drug; and • Determine whether a generic equivalent or other therapeutic alternative to the specified drug is available and, if so, compare pricing. myCIGNA.com also offers money-saving coupons, with incentives for members to consider generics. And educational alliances with well-known medical information providers enable quick reference to medication characteristics and comparisons.

F. Lichtenberg, “Are the Benefits of Newer Drugs Worth Their Cost? Evidence from the 1996 MEPS.” Health Affairs. Sept/Oct 2001: 5:241-251. The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2006 Annual Survey. 3 CIGNA Actuarial Sourcing and Underwriting. 4 CIGNA Best Total Results collateral piece, page 2. 5 “How Consumerism is Changing the Health Insurance Industry—Q&A with David Cordani.” Strategy + Business. March 27, 2007. www.strategy-business.com/li/leadingideas/li00019?tid=230&pg=all 6 National Council on Patient Information and Education. Newsvine Report: “Skipping Doses Could be Deadly. “ www.newsvine.com/_news/2007/07/30/867467 7 EW Boehm et al. Rx Adherence Hits the Ignorance Wall. Forrester. April 2006. 8 “Patient Compliance: A Problem that Plagues the Healthcare Industry.” Pharmacy Times. April 7, 2006. 9 DA Reiger, WE Narrow, DS Rae, et al. “The defacto US mental and addictive disorders service system: Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services.” Archives of General Psychiatry. 1993; 50:85-94. 10 CIGNA Commercial Book of Business as of 1/1/07. 11 Pharmacy Benefit Management Market Overview — 2007. (A BusIntel Report). KnowledgeSource. April 2007. 12 Citigroup Industry In-Depth Report on PBMs. May 10, 2007 13 “Specialty drugs to drive future health costs.” Benefit News.com. www.benefitnew.com/pfv.cfm?id=8064. 1

2

Alavert is a registered trademark of Wyeth Consumer Healthcare and Prilosec OTC is a registered trademark of Proctor & Gamble.


Health insurance expenses are the fastest growing cost component for employers. Unless something changes dramatically, health insurance costs could overtake profits by 2008. Source: McKinsey and Company

PUT CIGNA TO WORK FOR YOU Are you ready to start getting a Return On Health ? To learn more about lowering your health trend, contact your CIGNA Account Representative today, or visit www.CIGNA.com.


CIGNA Pharmacy Management

CIGNA Pharmacy Management CIGNA 900 Cottage Grove Road Hartford, CT 06152 www.CIGNA.com “CIGNA Pharmacy Management” is a registered service mark, and “Return On Health” is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. “CIGNA Pharmacy Management” refers to operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation. © 2007 CIGNA Pharmacy Management. All rights reserved. 811482

The Clinical Difference Delivering Return On HealthSM Through Clinical Integration


The CIGNA Brand Center Basic Guidelines and Policy March 2008


T h e C I G N A B r an d Introduction The CIGNA Brand Identity Program is designed to clarify who we are, what we do and what we stand for. Following these guidelines will help keep our brand strong and clearly differentiate us from our competitors. Through the consistent, widespread use of our powerful and communicative Trademark – and distinctive graphic standards – we will continue to increase the awareness of our name and continue to build on our image as a responsive, caring and approachable provider of health care and related employee benefits. If you have questions on anything you see here, contact CIGNA Brand Management at 860.226.7050 - Cigna.Brand.Management@CIGNA.com.

How to Use These Guidelines This document is a series of linked Adobe Acrobat PDF files. You can access them online or print a set out to refer to when a computer is not readily accessible. You won’t need to start from scratch with each application you produce. Instead, follow the basic standards or refer to the specific section you are interested in for guidance.


Table of Contents The CIGNA Brand. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Basic Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Color . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Trademark Color Options . . . . . . . . . . . . . . . . . . . . . . . . . 7 Tree Pattern. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Typography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Online Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Literature & Communications Development. . . . . . 12 Look and Feel of Communications & Other Touch Points. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Brand Imagery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Promotional Merchandise . . . . . . . . . . . . . . . . . . . . . . . 13 Signage & Branded Environments. . . . . . . . . . . . . . . . 14 Stationery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 External Use of CIGNA Name And/Or Logo. . . . . . . .14 Intellectual Property Issues. . . . . . . . . . . . . . . . . . . . . . . 16


CIGNA Brand Guidelines – March 2008

T h e C I G N A B r an d A Brand is an intangible asset that is made up of a set of expectations based on what our customers glean from what we promise and, more importantly, how we perform. The CIGNA Brand is best represented by the following mission, values and imperatives – and by the guidelines following. Our Mission – Why We Exist: “To help the people we serve improve their health, well-being and security.” Our Imperatives – What We Do: “Have the best people” Commit to being the best and having the best people working collaboratively toward common goals Constantly upgrade skills and capabilities Seek, manage and embrace diversity in sources, backgrounds, experiences and points of view “Know our customers” Develop “customer insights capability” that is world-class Understand unmet and latent needs Leverage those insights across everything we do “Nail the basics” Flawlessly execute the fundamentals Identify and eliminate customer “pain points” Meet or beat customer needs “Improve all the time” Get better every day, every month, every year Drive continuous cost and quality improvement Be a “learning organization”; have a thirst for new ideas; refresh our “view of the future” Innovate like crazy; experiment, using pilots to learn “Live and breathe performance” Demonstrate and demand personal accountability, owning results, rewards and consequences Continuously upgrade performance standards Ensure resources (time, money, people, mindshare) are aligned to maximize value creation The Way We Work Together – How We Do It: We treat others with respect and integrity at all times. We trust our colleagues, expecting the best of each other. We seek alignment by constructively engaging in fact-based discussion. We actively listen, and seek advice and counsel from others when making major decisions. We do what’s right for CIGNA, not just for our organizational unit. We act with speed – crisp meetings, clear decisions, action orientation. We hold ourselves and each other accountable, recognizing those who achieve results and adhere to The Way We Work Together.

TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding




CIGNA Brand Guidelines – March 2008

B asic S tan d a r d s Basic Standards Introduction The foundation of the CIGNA Brand Identity System is our Trademark. It is one of CIGNA’s most valuable assets and is legally protected only if it is used properly and consistently. To protect the CIGNA Trademark and to maintain a consistent image, it is important to understand these basic standards. If you have questions, contact the office of Brand Management at 860.226.7050 - Cigna.Brand.Management@CIGNA.com.

The Trademark Tampering with the trademark jeopardizes our ability to protect it from legal infringement. Symbol Logotype

The CIGNA Tree of Life is a hand-drawn symbol based on an early American quilt motif. It is a familiar image with a strong heritage that embodies attributes reflecting CIGNA’s history and longevity. Our Tree of Life is warm, human and rich in meaning – signifying growth, health, protection, stability, approachability, responsiveness, and life itself.

Closely linked to the symbol is our name. The letterforms of the CIGNA Logotype are specially created and must never be typeset or altered in any way. The Trademark is formed by two essential parts: The Tree of Life Symbol and the CIGNA Logotype. To ensure legal protection the Tree Symbol must never be used independent of the Logotype, although the Logotype CAN be used separately. In text, the company style is to express our name in either all Capital letters – or in caps and small caps. Although most media outlets refer to us as Cigna in print, that has more to do with how the style manuals those organizations follow determine the capitalization of our company name based on the way it’s pronounced. Using all caps celebrates the fact that our company is the result of the 1982 merger of two well-respected companies, INA & CG (The Insurance Company of North America and the Connecticut General Life Insurance Company). The Trademark should never be redrawn or the words typeset. The ® mark should always appear when the Trademark appears – unless it will appear so small or is reproduced in such a way that it would be illegible. Conversely, when scaling the logo up to a large size, the ® mark should not scale proportionally large. See Incorrect Trademark Treatment for some incorrect examples. Art for the trademark in all appropriate file formats is available by contacting the office of Brand Management at 860.226.7050 - Cigna.Brand.Management@CIGNA.com. Note: The logo used in the CIGNA Word Macro is actually a custom typeface, so if a communication containing this “CIGNA Logo” typeface is emailed outside the company, the letter “A” will appear on the recipient’s system instead. To correct the situation either save your letter as a PDF – if you have access to the full version of Adobe Acrobat – or replace this logo typeface with a graphic of the correct logo.

Business Signatures Originally intended to help our diverse audiences better understand the breath of our products and services, we are phasing out their use. Now that we are focused on providing our customers with, expertise and services that improve the health, well-being and productivity of their employees, they are less important. If there is a business or legal reason to continue to use a Business or Regional HealthCare Signature, they are still available. Business Signatures do not require register marks. TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding




CIGNA Brand Guidelines – March 2008

C olo r The CIGNA Palette Primary Colors: Teal

Gray

CIGNA Brand Colors Our primary brand color is CIGNA Teal – or PMS 315C. We want CIGNA to be strongly associated with this color. All materials that do not employ prepared templates should use this color broadly across their communications.

PMS

315

CG9C

CMYK

C-100 M-0 Y-12 K-43

C-0 M-0 Y-0 K-60

CIGNA Teal is complimented by CIGNA Gray – or PMS Cool Gray 9. (A 60% screen of black is a permissible substitute for CIGNA Gray.)

RGB (MAC)

R-0 G-113 B-133

R-124 G-124 B-124

RGB (WIN)

R-0 G-102 B-133

R-147 G-147 B-147

In addition to CIGNA Teal and Gray, a palette of supporting colors is available. This palette was developed to provide flexibility, which may be necessary in differentiating products and in communicating to diverse audiences. The color palette shown below should be used to provide color accents, to highlight specific images or text, to color code, and/or to convey a particular mood or impression. Screen tints of the supporting colors are permissible.

HEX

00718F

919295

Supporting Colors

Supporting Colors:



Blueberry

Bronze

Clementine

Concord

Espresso

Kiwi

Nickel

Olive

Pomadoro

Sunrise

PMS

7462

WG9C

7413

669

7533

583

7536

371

1805

130

CMYK

C-100 M-50 Y-0 K-10

C-0 M-11 Y-20 K-47

C-0 M-53 Y-100 K-4

C-76 M-78 Y-0 K-47

C-0 M-22 Y-85 K-85

C-23 M-0 Y-100 K-17

C-0 M-4 Y-22 K-32

C-43 M-0 Y-100 K-56

C-0 M-91 Y-100 K-23

C-0 M-30 Y-100 K-0

RGB (MAC)

R-0 G-103 B-172

R-153 G-139 B-125

R-236 G-136 B-28

R-53 G-43 B-101

R-74 G-56 B-0

R-175 G-188 B-33

R-185 G-176 B-152

R-74 G-96 B-28

R-191 G-48 B-25

R-253 G-184 B-18

RGB (WIN)

R-0 G-103 B-172

R-181 G-158 B-117

R-253 G-184 B-34

R-53 G-43 B-101

R-89 G-61 B-5

R-169 G-221 B-1

R-204 G-196 B-122

R-81 G-119 B-5

R-214 G-37 B-2

R-250 G-228 B-22

HEX

00C66

9A8C7D

EE8A1D

352C66

4B3900

AFBD21

B9B299

4F6F18

BF2E1A

FDB813

TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding


CIGNA Brand Guidelines – March 2008

T r a d e ma r k C olo r O ptions To strengthen the association of the colors Teal and Gray with our brand, the first choice for the Trademark should be CIGNA Teal and CIGNA Gray – over a white field. But all Teal, all Black and several other options are available. If the logo needs to be placed over a color field, use the following as a guide. Separate logo artwork for positive, reverse and special situations is available by contacting the office of Brand Management at 860.226.7050. White Field (preferred)

CIGNA Sunrise CIGNA Sunrise

CIGNA Clementine CIGNA Clementine

CIGNA Pomadoro CIGNA Pomadoro

CIGNA Concord CIGNA Concord

CIGNA Blueberry CIGNA Blueberry

CIGNA Kiwi CIGNA Kiwi

CIGNA Olive CIGNA Olive

CIGNA Nickel CIGNA Nickel

CIGNA Bronze CIGNA Bronze

CIGNA Espresso CIGNA Espresso

TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding




CIGNA Brand Guidelines – March 2008 Incorrect Trademark Treatment Misuse of the CIGNA Trademark places its legal protections at risk and compromises our image. Some common misuses of the trademark are shown in the following examples. Although these examples do not include every incorrect use, they will give you an idea of the areas to double-check. To ensure correct reproduction, always use the proper artwork. Do Not Reposition or resize Logotype relative to symbol

Do Not Outline

Do Not Shadow Trademark or use other dimensional effects

Do Not Use transparent logo over certain backgrounds

Do Not Position over busy background (high-contrast photo background)

No

Yes

Clear xSpace Clear space is the area around our Trademark where no text or graphic element may intrude. It is important to allow for clear space 3x the Trademark in order to protect the proper framing and preserve the visual integrity of our brand mark. around Minimum clear space is equal to one-third the height of the Trademark. x The examples here show various situations with the correct minimum clear space. x

x

x

x

3x

3x

x x

x

x x

x

Tag Line x

Our former tagline, “A Business of Caring” is no longer in use. Do not throw out materials where it appears, but eliminate it in any work in production. And continue to look at this resource as additional updates will be posted s they become available. 3x

x x

x

TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding




CIGNA Brand Guidelines – March 2008

T r e e Patt e r n The tree pattern art uses part of the outline art created for the Tree Symbol as a design element. Sized and arranged to work in various formats, it must bleed off at least one side of a given format – or end at a non-bleeding border device. If desired, the tree pattern may be placed at different angles. A minimum of three leaf/fruit shapes should always be visible while a maximum of 60% of the total tree pattern may be used, with the lower trunk and base being the excluded elements.

-JGFTUZMF.BOBHFNFOU1SPHSBNT

Never create tree patterns from the Trademark. Rather, use the tree pattern artwork available by contacting the office of Brand Management at 860.226.7050. 8FJHIU.BOBHFNFOU 5PCBDDP$FTTBUJPO 4USFTT.BOBHFNFOU

Tree Pattern Color

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TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding

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CIGNA Brand Guidelines – March 2008

T ypog r ap h y CIGNA Typeface Typography is an important element in establishing a distinctive visual style for CIGNA communications materials. Our brand identity system includes both primary and supporting typefaces. They may be used in various weights in order to provide flexibility while maintaining a consistent typographic style.

Stone Serif Medium & Italics Stone Serif Semibold & Italics Stone Serif Bold & Italics

Stone Serif Standard, in all weights, is CIGNA’s primary typeface. Substitute typefaces should not be used. ITC Stone Serif Standard is an International Typeface Corporation OpenType font. A True Type version of this font family is a part of the standard CIGNA-link desktop build. Given current technical limitations with the electronic delivery and display of CIGNA materials, exceptions have been made for the substitution of body copy in many applications – see note at end of section.

Supporting Typefaces The Myriad Pro OpenType family comprises the complete set of supporting typefaces. These faces should be used to highlight specific text such as subheads, captions and graphs. Myriad should not be used to typeset large amounts of body copy in print, but this and similar sans serif faces are acceptable for body copy intended for electronic display.

For Windows-based Communicators: Myriad Pro Light Condensed Myriad Pro Regular

Myriad Pro Bold Condensed Myriad Pro Bold

10 For Graphic Design Staff: Myriad Pro Light Myriad Pro Light Italic Myriad Pro Myriad Pro Italic Myriad Pro SemiBold Myriad Pro SemiBold Myriad Pro Bold Myriad Pro Bold Italic Myriad Pro Black Myriad Pro Black Italic Myriad Pro Light Condensed Myriad Pro Light Condensed Italic Myriad Pro Condensed Myriad Pro Condensed Italic Myriad Pro SemiBold Condensed Myriad Pro SemiBold Condensed Italic Myriad Pro Bold Condensed Myriad Pro Bold Condensed Italic Myriad Pro Black Condensed Myriad Pro Black Condensed Italic

Myriad Pro Light SemiCondensed Myriad Pro Light SemiCondensed Myriad Pro SemiCondensed Myriad Pro SemiCondensed Italic Myriad Pro SemiBold SemiCondensed Myriad Pro SemiBold SemiCondensed Italic Myriad Pro Bold SemiCondensed Myriad Pro Bold SemiCondensed Italic Myriad Pro Black SemiCondensed Myriad Pro Black SemiCondensed Italic Myriad Pro Light SemiExtended Myriad Pro Light SemiExtended Italic Myriad Pro SemiExtended Myriad Pro SemiExtended Italic Myriad Pro SemiBold SemiExtended Myriad Pro SemiBold SemiExtended Italic Myriad Pro Bold SemiExtended Myriad Pro Bold SemiExtended Italic Myriad Pro Black SemiExtended Myriad Pro Black SemiExtended Italic

TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding


CIGNA Brand Guidelines – March 2008 Special Display Typefaces Special display faces are also cross-platform OpenType typefaces used only to create unique title bars, mastheads, primary subheads, initial caps and other decorative embellishments. They should be used sparingly and with discretion. They are: Copperplate Gothic 29 AB Copperplate Gothic 29 BC Copperplate Gothic 30 BC Copperplate Gothic 31 AB Copperplate Gothic 31 BC Copperplate Gothic 32 AB Copperplate Gothic 32 BC Copperplate Gothic 33 BC Copperplate Gothic 30 AB Copperplate Gothic Bold Copperplate Gothic Light

Latin MT Standard Snell Roundhand

Exceptions for Digital Delivery: People working in print or other media using applications that allow for type to be exported to raster-based graphic formats can make use of a wider selection of CIGNA-approved typefaces. Staff developing communications for internal distribution using standard Windows applications are limited to the Stone Serif Standard family of faces and four Myriad Pro faces. But these people should take care to embed these faces in their documents before sharing them internally or externally as the Myriad faces will not be widely distributed at CIGNA. When working in applications that do not make use of embedded typefaces (like email and browser-based communications) or when emailing a CIGNA letter externally, commonly available Windows faces should be substituted for CIGNA fonts based on the following list. Our “logo” typefaces – the CIGNA Trademark and Registered Trademark faces loaded on all CIGNA desktops should be replaced with logo graphic files available by contacting the office of Brand Management at 860.226.7050. CIGNA Font

Replacement for Electronic Delivery

Stone Serif Medium

Times New Roman

Stone Serif Semibold

Times New Roman Bold

Stone Serif Bold

Times New Roman Bold

Myriad Pro Light Condensed

Arial Narrow

Myriad Pro bold Condensed

Arial Narrow (Bold)

Myriad Pro Regular

Verdana

Myriad Pro Bold

Verdana Bold

Latin MT Standard

none (use graphically-generated text)

Snell Roundhand

none (use graphically-generated text)

Copperplate Gothic 29 AB

none (use graphically-generated text)

TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding

11


CIGNA Brand Guidelines – March 2008

O nlin e M e d ia For the design of interactive applications and other online content follow current CIGNA.com standards located here. The CIGNA name and mark cannot appear on an external (non-CIGNA) website without prior approval of the office of Brand Management.

L it e r atu r e & C ommunications D e v e lopm e nt

12 Contact CIGNA Creative Services by calling Gina Maliga at 860.226.3646 or Gina.Maliga@CIGNA.com to initiate internal communications development work or to get copies of the latest templates. You should not retain any outside individual or firm without the prior approval of CIGNA Brand Management, who will conduct a brand overview session for any new vendors as a condition of work.

Loo k an d F e e l of C ommunications & Ot h e r Touc h P oints Look and Feel guidelines for all consumer touch points have been assembled by the Customer Experience Organization, architects of the end to end customer experience at CIGNA. It’s critical that we employ messaging and materials that look and feel consistent, and make all interactions at customer touch points clear, concise and easy to understand -- consistently throughout CIGNA. Look here for those guidelines. Words and Phrases commonly used across our company need to be replaced with simple, consistent language in individual communications and collateral. They include CIGNA-specific or insurance industry language and other awkward phrases that, in most cases, should be replaced with words that keep things simple. Look here for guidelines on words.

TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding


CIGNA Brand Guidelines – March 2008

A d v e r tising Do not develop advertising locally. Instead contact your business’ marketing department. All advertising shall be placed through Creative Services. Staff placing ads will confirm that each submission contains the appropriate “legal line” that clarifies the company that is advertising and states its relationship to CIGNA Corporation. See Legal Line Guidelines for more information. All new or revised placements shall be reviewed by the appropriate legal and compliance resources. For community service or event advertising, a selection of prepared ads is available. To resize or customize one of these ads – or to develop a custom ad for a special local event, contact CIGNA Creative Services.

B r an d I mag e r y The right images reflect positively on our understanding of our various business constituencies and their needs. Used properly real people photographed in logical settings will enhance the impressions we want our customers to have of CIGNA. The CIGNA Image Library was created to repurpose imagery licensed to CIGNA, reinforcing the positive impressions these photos were designed to make – while reducing costs. To download imagery at no cost from http://cigna.indexstock. com please activate an account by contacting the office of Brand Management at 860.226.7050. Communication vendors working on CIGNA projects can also get access the same way. Any new photography needed for marketing communications must be approved by CIGNA Brand Management. Contact Brand Management or call 860.226.7050.

P r omotional M e r c h an d is e CIGNA-branded promotional merchandise is available through our approved promotional vendor, eCompanyStore. To look at the current selections go to the CIGNA Tree of Life Collection. Assistance is also available to help select and decorate custom merchandise for a special event or need. For assistance with custom materials, go the CIGNA Tree of Life Collection website and select custom order link in the web page’s left-hand navigation for more information.

TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding

13


CIGNA Brand Guidelines – March 2008

S ignag e & B r an d e d En v i r onm e nts Signage is an integral part of our Brand Identity system. And integrating CIGNA-branded visuals and messages into an office environment completes the package. These unique spaces underscore our mission, vision and values to visitors and staff alike. For signage or to discuss environmental branding options as part of an office move/renovation, contact your Corporate Real Estate Representative. For further questions about CIGNA-branded environments, email Mark Swayne Mark.Swayne@CIGNA.com or call him at 860.226.7050.

S tation e r y As the primary source of communication to our customers, CIGNA stationery should present a consistent, unified and professional image.

John Doe Director of Marketing CIGNA HealthCare

Month Day, Year

11095 Exeter Avenur Anytown, ST 12345 Telephone 123.456.4321 Facsimile 123.456.1234 John.Doe@CIGNA.com

Addressee’s Name Title Company Name Street Address City State ZIP Code

Salutation: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean vitae turpis id quam pretium pulvinar. Nunc neque. Pellentesque habitant morbi tristique senectus et netus et malesuada fames ac turpis egestas. Phasellus cursus magna ac odio. Integer ultrices. Duis dapibus nonummy turpis. Sed vehicula faucibus ligula. Cras semper, velit eget hendrerit posuere, tortor lorem bibendum augue, et pulvinar leo est sit amet ligula.

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10.5 point Stone Serif is the default size and face in the CIGNA-link Word Stationery Macros. It should be used in all letters unless something is to be emailed externally. In that case, please refer to the exceptions for digital delivery section on page 11. Preprinted stationery for all CIGNA businesses is available through CIGNA Printing & Distribution’s online ordering system, @winXS. Business cards can be ordered here also. If you are unfamiliar with this resource, call or email Jim Magennis at 860.226.7416 or James.Magennis@CIGNA. com for assistance.

Personalization of individual letterhead can be done on CIGNA workstations by using the CIGNA-link Word Stationery Macros. To reduce expenses for noncritical communications, letters can also be created using plain paper. Sincerely,

Sender’s Name

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You must obtain approval from CIGNA Brand Management staff before granting permission to vendors or other organizations to use the CIGNA name and/or logo. Requests to use our name and brand in connection with non-CIGNA advertising, sales promotions or other communications need to be individually reviewed. If approval is obtained, CIGNA Brand Management will furnish the appropriate brand mark, review and approve intended uses, and coordinate obtaining a signed license agreement from CIGNA Intellectual Property covering such use. Endorsements A quote from a CIGNA Employee or a CIGNA authorized case study in a vendor’s communication can be considered an endorsement. This is different from including the CIGNA logo amd/or name in a vendor’s client list. Endorsements by CIGNA can lead to situations where our product and services are not evaluated on “A level playing field”, by customers or prospects working in the same fields as our endorsed vendors. CIGNA, therefore does not generally permit this practice, although concessions may be necessary for strategic and/or financial reasons. TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding

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CIGNA Brand Guidelines – March 2008 Co-branding Co-branding is a very effective way to strengthen the CIGNA brand in existing markets, and to build it more efficiently in new ones. Co-branding encompasses a wide range of activities and relationships between CIGNA and one or more associate companies. Permitting these companies to use the CIGNA name and brand marks when marketing specific products and services and using our partners’ brands in our promotions, or producing common communications, results in co-branding. A co-branding relationship should exist/be proposed to enhance CIGNA’s brand value and business performance. Any partnership must produce benefits for both brands in order for co-branding to be appropriate. Note: Companies providing products and services in the course of fulfilling a CIGNA benefits package are frequently considered vendors and are generally not candidates for co-branding. The way a co-branding relationship is handled depends on many variables and needs to be built on a case-by-case basis. Some general examples follow, but are included only as such and not as templates. CIGNA Brand Management needs to be involved in this process (see below). Co-branding Categories:

CIGNA Exclusive: associate company invisible

XYZ Company

Shared Emphasis: equal contributions

CIGNA Dominant: dominant CIGNA contribution, associate as service provider

Associate Dominant: dominant provider contribution as a feature of a CIGNA benefit

Associate Exclusive: CIGNA invisible (IE ASO or similar private-label business

New Brand: Free-standing brand formed by collaboration/partnership

TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding

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CIGNA Brand Guidelines – March 2008 Co-branding Process: Contact the office of brand management and be prepared to provide information about the proposed relationship. This dialog might include: Business and strategic reasons to implement relationship. Potential partner’s market reputation. Is this reputation a fit with the CIGNA Brand? Is this relationship exclusive to both parties? Obtaining Approved Logo Art Logo art can be obtained from CIGNA Brand Management. Call the office of Brand Management at 860.226.7050 - Cigna.Brand. Management@CIGNA.com. To get the correct art for your need, please be prepared to specify the file format you need the mark in, its size, and if you know whether or not it will be placed over a color field. Absent that information, knowing the intended end use(s) will help narrow down the options.

I nt e ll e ctual P r op e r ty I ssu e s What is Intellectual Property? Intellectual Property (IP) refers to all types of confidential knowledge (like trade secrets, designs, know-how etc.) and includes patents, design patents, trademarks, domain names and copyrights. Why is it Important? The registration of Intellectual Property is important as it allows us to patent and to protect solutions that give the company a competitive edge. The primary goal of the CIGNA Intellectual Property Unit is to protect CIGNA products from unlawful exploitation, to promote sales, support licenses, to ensure we are not hindered from selling our own products, and to protect the reputation associated with the name “CIGNA.” Protecting the CIGNA Brand Full compliance with the basic visual standards section of this document not only ensures that the CIGNA brand is properly represented; it will help protect the brand as a business asset of CIGNA. Misuse of the Trademark or Logotype could jeopardize our legal ability to protect the exclusivity of the brand. Anyone using the CIGNA brand therefore shares an obligation to represent it correctly in all communications. All published material must be protected by copyright notice, in the form: “© 20XX (year of first publication) CIGNA.” This applies regardless of the publishing location or business unit. Naming Policy The purpose of the CIGNA Naming Policy is to keep the communications focus on the CIGNA Brand. The name of a CIGNA product or service should convey the key attributes or value of our offering in an easy-to-understand name that’s consistent with existing company nomenclature.

TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding

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CIGNA Brand Guidelines – March 2008 All new external names cannot be released until reviewed by CIGNA’s Corporate Brand Management and Legal teams. The information below outlines the process. Name Categories Overview Names developed for CIGNA products usually fall into categories referred to as “generic” and “descriptive.” In certain situations, a third type labeled “suggestive” may be called for. A Generic Name is the common descriptive name of a product or service. Generic names are typically easily understood, but cannot be registered and protected as licensed trademarks. A Descriptive Name also requires very little explanation and is generally easy to understand. It directly describes the nature, quality, benefits or attributes of a given product or service. Descriptive names cannot usually be trademarked but, with substantial use, they can achieve a secondary meaning and may eventually be trademarked. A Suggestive Name is a coined name that contains little or no direct meaning about the product or service it represents. This type of name should only be used to represent business initiatives that will be significantly funded and will add unique long-term strategic value to the business. Suggestive names should be registered with the Patent and Trademark Office* *See the “Creating New Names: Process” below. Names must: Be preceded by the CIGNA Name (unless this will be a stand-alone brand). Be positive or neutral in impact on the CIGNA Brand. Be legally available. Be free of acronyms and intentional misspellings. Always be used in their entirety. (They should never be shortened or abbreviated in media or speech the first time they are used – but can be shortened with additional usage communication-by-communication.) Never be graphically stylized, joined with a graphic element or used as a logo. Product names should always appear in a CIGNA-approved typeface. Creating New Names/Process: Step 1 – Naming Directions/Creative Routes: Establish two to four naming directions or creative routes that can be used to guide name ideation. These should be based on key product attributes, functional or emotional benefits, target markets, or positioning points. Step 2 – Naming Categories: Once you have defined the creative routes, decide on a naming category. Step 3 – Name Ideation and Submission: Generate names with a brainstorming team according to chosen creative routes and selected naming category. Generate a lot of names and select the three to five best candidates, ranked by order of preference. Step 4 – Review and Approval: Submit these names to Mark Swayne, CIGNA Brand Management for review. Once the initial review is completed, the names will be submitted to CIGNA Intellectual Property to determine if the names are legally available. The Brand Management team will review Suggestive Name options with CIGNA’s Brand Governance Council. The final selection of any name, if legally available and approved by the Brand Management Team, will be submitted to the Patent and Trademark Office and can be used in the marketplace. TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding

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CIGNA Brand Guidelines – March 2008 Respecting Others’ Intellectual Property: As part of the company’s commitment to ethical business conduct for all employees, it is critical that we respect the intellectual property of others. Physical and digital resources that are copyrighted and/or licensed must be properly and legally acquired, with full transparency and documentation when appropriate. This includes, but is not limited to, the following common communications tools: CIGNA corporate typefaces. These must be purchased and licensed by each individual user. It is a violation of copyright law to freely distribute them, even within the company. But it is permissible to send a copy of the fonts along with a project to a printer, to ensure proper reproduction. Professional graphic arts software. Popular software such as Adobe InDesign, Photoshop, Corel, etc. is normally licensed for installation at one workstation only. It is unlawful to copy or distribute such resources to secondary workstations, employee computers at home, or any other users without obtaining the proper licensing agreement. Images, graphics and illustrations. Photographs that are not the copyrighted intellectual property of CIGNA require licensing to be distributed by CIGNA. This includes customer-supplied photographs, commercial stock photography (per-incident or royalty free), and other previously published materials, whether physical or electronic. It is the responsibility of each user to understand the license agreement, and to fully comply with all terms and conditions. The CIGNA Image Library contains imagery licensed exclusively to CIGNA, much of it commissioned specifically for the company. This collection is available free of charge to employees and vendors working on CIGNA business. When using images provided from a customer, please obtain written documentation of their permission to use the photographs prior to publishing, which clearly states the terms of usage – is the image supplied for a single project, or may CIGNA use the image freely, in perpetuity? Is additional compensation or notice required? When commissioning photography of people, whether CIGNA employees, professional models or other people who are neither professional models or CIGNA employees, you must obtain a signed photo release prior to taking any photographs. Please contact Mark Swayne for more information. Most royalty-free digital images do not allow the customer-based distribution of their images, whether individual shots or CD-ROM collections, through any freely downloadable software interface. Third party brands. We must show respect for our business partners’ brand assets, just as we expect third parties to respect the importance of our brand. Any representation of our customer, competitor, supplier or channel partner’s brands should follow all the conventions of their visual identity system. In instances where CIGNA’s visual identity system conflicts with third parties, please consult your brand council representative or Mark Swayne, for guidance.

TOC | Introduction | Colors | Tree Pattern | Typography | Advertising | Imagery | Promotional Material | Signage | Co-branding

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CIGNA