Page 1

27-2056 A&R A.qxd

9/27/07

4:47 PM

Page 1

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 Changing behavior to deliver a Return On Health

SM


27-2056 A&R A.qxd

9/27/07

4:47 PM

Page 2

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


27-2056 A&R txt A.qxd

9/27/07

4:34 PM

Page 2

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.

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.

1


27-2056 A&R txt A.qxd

9/27/07

4:34 PM

Page 3

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


27-2056 A&R txt A.qxd

9/27/07

4:34 PM

Page 4

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


27-2056 A&R txt A.qxd

9/27/07

4:34 PM

Page 1

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.


27-2056 A&R A.qxd

9/27/07

4:47 PM

Page 1

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 Changing behavior to deliver a Return On Health

SM

CIGNA 03  

Impro ve Outco mes Educa te Reduc e costs Incen t CIGNA Pharmacy Management Clinical Management Changing behavior to deliver a Return On Hea...

Read more
Read more
Similar to
Popular now
Just for you