Cigna’s Patient Assurance ProgramSM expands, making more meds more affordable

When vital medication becomes more affordable for customers, this helps promote better health. That’s where the Patient Assurance Program (PAP) comes in. For eligible customers who manage a chronic condition, like diabetes, the program caps prices at $25 for a 30-day (one-month) supply. As of April 1, 2021, the program will expand to include these additional branded diabetes medications, based on the client elected formulary: Insulin Lispro, Lyumjev, Ozempic, Rybelsus, and additional strengths of Trulicity.

All of this value applies automatically at the pharmacy (retail or home delivery) for enrolled customers. It’s just another example of how the program continues to grow from its initial focus. At the time PAP launched in 2019, the focus was on certain types of insulins. As of July 2020, the program expanded to include additional branded diabetes medications for customers using a non-insulin product to help manage their blood sugar. As of January 1, 2021, the program grew to also include Trijardy XR – indicated to treat type 2 diabetes.

Overall, the Patient Assurance Program continues to:

  • Help make costs more affordable and predictable for insulin and certain other products.
  • Cap the customer’s out-of-pocket costs at no more than $25 for a 30-day supply; and no more than $75 for a 90-day supply (per prescription) any time the customer fills eligible products through the benefit plan.1
  • Help ease the burden of individuals paying high out-of-pocket costs for products like insulin. This is particularly helpful for those with coinsurance or those who must satisfy a high deductible before their insulin is covered.

Access to the expanded PAP applies automatically to all clients enrolled in the program. No action is required. The April 2021 changes will positively impact customers in the program who use eligible products to help manage their blood sugar.

Overall, PAP is available to Cigna Pharmacy clients to enroll in upon renewal or plan start. This program is not available to Medicare or Medicaid plans. Insured plan availability is also dependent upon state filing approvals.

The Patient Assurance Program is a blueprint for other therapeutic areas where customers may be exposed to higher out-of-pocket medication costs – which may affect adherence for some customers.2

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  1. The drug manufacturer value of this program is applied at the point of sale. Actual customer cost may be less depending upon plan design. Plans with higher copays may have to absorb additional cost to get the customer to $25, after discounts from the drug makers. Client must have elected to enroll in the program and must have benefit designs that align to the program requirements. Medication eligible for the reduced cost share vary based on client elected formulary. 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. Out-of-network coverage may be excluded or limited by plan terms.
  2. Health IT Analytics, Cost is a Primary Driver of Medication Non-Adherence Rates, Jennifer Bresnick, 9/2017.

Patient Assurance Program is a trademark of Express Scripts Strategic Development, Inc.

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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 details of coverage, review your plan documents or contact a Cigna representative.

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