Help for opioid users thanks to utilization management tactics

Addiction and overdose affect us all – individuals and families, employers and communities.

Cigna is committed to the fight against opioid misuse and overdose. We have set a goal to reduce overdoses among our commercial customers in key markets by 25% by December 2021.1 Our combination with Express Scripts helps strengthen our work to meet this goal.

As part of the upgrade to the Express Scripts claims engine, opioid utilization management (UM) programs will automatically be included as part of the standard offering to all Cigna Pharmacy clients. This will be provided at no additional cost to clients and will be included for clients regardless of their selection of a UM package.

This enhancement will help ensure that when opioids are necessary, they are:

  • Used safely and effectively
  • Taken appropriately
  • Administered in a quantity consistent with guidelines

Our stronger utilization management programs help address and reduce opioid misuse by applying extra scrutiny. This additional layer of review makes sure that a drug is appropriate to be approved for coverage. As a result, customers receive coverage for the right medication, in the right amount and for the right situation.

For more about Cigna’s actions to reduce opioid overdoses, please review these resources:

  1. Initial focus will be on the following targeted U.S. communities where a sizable number of Cigna commercial customers reside and where there are higher incidences of overdose. These include: Connecticut, Maryland, New Jersey, Virginia, Chicago, New York City, Philadelphia, Washington, DC.

“Express Scripts” is a trademark of Express Scripts Strategic Development, Inc.

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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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