As a result of our combination with Express Scripts, Cigna has strengthened our existing gaps in care solution, Well Informed Gaps in Care, by also offering RationalMed® for Cigna. It is a way to help improve the health and safety of our members as well as drive further affordability for our clients. RationalMed for Cigna is a proprietary gap in care engine, administered by Express Scripts, that will add a robust set of net new provider alerts.
Gaps in care occur when individuals do not receive or adhere to care that is consistent with medically proven guidelines for prevention and treatment. These gaps can result in more serious illness. This drives higher rates of hospitalizations, absences from work or home activities and increased costs for both customers and employers.
Well Informed currently leverages medical, pharmacy, and laboratory data to proactively identify gaps in care. It results in a 30 percent gap closure rate with savings of $2.12 per member per month (PMPM) on average.* RationalMed for Cigna will work in addition to Well Informed and is estimated to yield an additional $0.63 PMPM in pharmacy savings for ASO clients, bringing the total value of Cigna’s gaps in care solutions to $2.75 PMPM or $33.00 per member per year (PMPY).**
RationalMed for Cigna focuses on pharmacy-related alerts for drug safety. Additionally, RationalMed for Cigna alerts release electronically in real-time to providers as part of their workflow.*** The alerts are easy, timely and efficient for providers to review.
RationalMed for Cigna is available at no additional cost to all fully integrated commercial clients, upon upgrade to our proprietary Express Scripts claims engine. No action is required from clients.
Please reach out to your account manager with any additional questions.
*Results based on internal analysis of 2016 Cigna internal book of business. Actual customer/client results will vary and are not guaranteed.
**Results based on internal analysis of 2019 study in the state of Tennessee. Actual customer/client results will vary and are not guaranteed.
***For providers and pharmacists, alerts release via electronic real-time messaging, fax and mail.
For customers who fill drugs at Accredo, alerts feed into Accredo’s Therapeutic Resource CentersSM for use by coaches and case managers.
"RationalMed" and "Express Scripts" are trademarks of Express Scripts Strategic Development, Inc.
Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. Some plans require use an in-network pharmacy for prescriptions to be covered. Coverage is subject to any plan deductible, copayment and/or coinsurance requirements. 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 prescription drug coverage, contact a Cigna 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), Cigna Behavioral Health, Inc., Cigna Health Management, Inc., Accredo Health Group, Inc., Express Scripts, Inc., ESI Mail Pharmacy Service, Inc., Express Scripts Pharmacy, Inc., Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., Lynnfield Drug, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. Policy forms: OK - HP-APP-1 et al., OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al. (CHLIC). The Cigna name, logo, and other Cigna marks are trademarks of Cigna Intellectual Property, Inc. "Express Scripts" is a trademark of Express Scripts Strategic Development, Inc. This newsletter is not intended for residents of New Mexico.
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