FEEL BETTER. CONNECTED.

Transcription

1 FEEL BETTER. CONNECTED. Connected across pharmacy and medical. To take you further. Katy Wong, RPh, MBA Vice President, Producer Relations Cigna Pharmacy Management Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Life Insurance Company of North America, Cigna Life Insurance Company of New York, or their affiliates

2 Cigna Specialty Pharmacy Management Fully connected to help drive health improvement and lower costs Pharmacy Specialty Medical Behavioral Disability Pharmacy 360 o view full benefit connectivity Comprehensive medical management Incentive alignment to achieve clinical outcomes Specialty Pharmacy Services full support Proactive, personalized support across benefits Extensive clinical management Connected support to help improve health and help provide better total value at a lower cost WHY IT MATTERS National physician fee schedule average medical discount of average wholesale price (AWP) AWP 30% 1 $39.3 M saved for 606 Specialty customers ($65k/customer) by changing site of care 2 Customers using Cigna SRx vs. retail: 7% higher medication adherence 3 21% lower specialty condition costs 3 15% overall lower medical costs 3 1. Aggregate book of business discount of AWP -30% under the medical benefit achieved through the national injectable and immunization fee schedule (NIIFS) Cigna s nationwide book of business 2014 report January-December Cigna national book of business match case control analysis Cigna Specialty Pharmacy Services vs. customers filling at retail. November

3 Drug-only focus misses the complete specialty pharmacy view to manage total health care spend Population 1 Cost 1 Impact 1 Pharmacy Customers 75k Both 17k Medical Customers 142k WHY IT MATTERS $400M other drug costs $1.34B other condition costs $2.76B specialty condition costs $1.62B self-administered specialty drugs $1.18B HCP administered specialty drugs $80M cost to administer drug Hospital stays 33k customers $1.2B in costs 96k bed days Emergency room visits 70k customers $223M in costs 234k (4%) of customers represent $7.4B (27%) of total health care costs 1 1. Cigna East specialty medication users, integrated pharmacy and medical benefits claim review. Integrated Data Source January-December

4 A complete specialty pharmacy view for clients to track spend Integrated breakdown of total spend across pharmacy and medical 4

5 TheraCare Helping customers feel better and stay healthier TheraCare helps customers taking specialty medications understand and manage their condition and treatment. HealthEview Connected clinical platform Integrated therapy management that extends across pharmacy and medical Dedicated clinical team Point of service engagement Prior authorization support Focused, one-on-one clinical support Collaboration with treating HCP Medication coordination through Cigna Specialty Pharmacy Services In-home care set up and training Coordination of financial assistance (if needed) > > WHY IT MATTERS 86% of customers with a specialty condition who were referred by the Customer Engagement Team agreed to therapy management with TheraCare Integrated Touchpoint Project - Cigna Internal analytics operational results reported Aug 2015, inbound Cigna Home Delivery Pharmacy call interactions -- 41% said yes to change their drug or pharmacy to save is from inbound call interactions to enterprise service center. 5

6 Specialty Care Options To help ensure infusion therapy is given in a cost-effective, clinically appropriate setting Specialty pharmacy customer in need of infusion therapy HCP submits prior authorization request for specialty drug Cigna Specialty Pharmacy Services evaluates medical necessity criteria SCO team looks to redirect the site of administration to less expensive settings when clinically appropriate Cigna Medical Director outreaches to treating HCP for peer-to-peer discussion about treatment options at a lower-cost setting 50%+ cost difference dependent on site of administration 2 Case manager outreaches to customer for agreement to transition care $39.3M saved for 606 customers with 75% doctor agreement 1 HCP and customer agree, SCO team collaborates with SRx Services to set up medication and care to help ensure there is no disruption in therapy 1. Cigna s nationwide book of business 2014 report. Full year 2014 savings. 2. Costs reflect eligible charges for 2015 DOS in Cigna East HMO/Network/OAP/OAPIN/PPO for in-network providers. 6

7 Volume to value pharmaceutical manufacturer incentives Innovative contracting rewards optimal health and cost-savings Outcomes based contracting Protects against inflation Ties cost of drug to effectiveness Leverages medical and pharmacy data, and superior analytics, to determine if the medication is delivering on outcomes Multiple Sclerosis (hospitalization rate) EMD Serono Rebif 97.1% individuals without relapse 2 38% reduction in hospitalizations 2 Hepatitis C ( cure rate ) Gilead Sciences Harvoni Innovative outcomes incentive alignment based on real world cure rate results across Cigna s population 98.4% SVR12 ( cure rate ) 3 Heart Failure (hospitalization rate) Novartis Entresto Outcomes incentives tied to health outcomes Primary metric is reduction in the proportion of customers with heart failure hospitalizations. High cholesterol (LDL-C levels) Amgen Repatha, Sanofi/Regeneron - Praluent Reduction in LDL-C (bad cholesterol) levels Analyze medical/pharmacy data to determine future cardiovascular improvements related to treatment with new PCSK9 inhibitors (beyond reduction in cholesterol levels) 1. Cigna book of business data 2015, utilizing the Gaps in Care Well Informed Evidence Based Medicine algorithms for medication adherence and lab results.. 2. Business Wire. CIGNA Receives Pharmacy Benefit Management Institute Innovation Award. February 17, Cigna internal claim analysis

8 Reimbursement incentive alignment to Transform PBM industry to unlock better health and affordability Pharma Manufacturers Physicians Dispensing Pharmacy Clients Outcomes based contracting Drug list management Lower cost agents (biosimilars) Collaborative Accountable Care Alignment Volume to value Pharmacy care coordination fee In-house pharmacy Specialty and chronic condition focused Adoption of valuable innovation Enhanced Specialty Care Options Consolidated Strategic Reporting Benefit design 8

9 Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and complete details of coverage, contact your Cigna sales representative. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company (CGLIC), Life Insurance Company of North America, Cigna Life Insurance Company of New York (New York, NY), Cigna Behavioral Health, Inc., Cigna Health Management, Inc., Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of Cigna Health Corporation, including Cigna HealthCare of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc., Cigna HealthCare of Florida, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Indiana, Inc., Cigna HealthCare of St. Louis, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of New Jersey, Inc., Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of Tennessee, Inc. (CHC-TN), and Cigna HealthCare of Texas, Inc. Cigna Specialty Pharmacy Services refers to the specialty drug division of Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C., doing business as Cigna Home Delivery Pharmacy. Policy forms: OK - HP-APP-1 et al (CHLIC), GM6000 C1 et al (CGLIC); TN - HP-POL43/HC-CER1V1 et al (CHLIC), GSA- COVER, et al (CHC-TN).The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc / Cigna. Some content provided under license.

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