Cigna’s medical specialty drug management update

Medical specialty drugs stand apart from traditional specialty drugs. They must be administered in a health care setting and are, thus, covered under the medical benefit. Medical specialty drugs comprise about half of all specialty drugs and make up about 23% of total health care spend.1

We help to manage medical specialty drug costs through:

  • Clinical utilization review
  • Site of care review
  • Provider engagement
  • Customer engagement
  • Aggressive cost control to preferring biosimilars

The promise of biosimilars
Cigna continues to create new strategies to manage the growing expense of specialty drugs for clients and customers. We keep a close eye on the biosimilar pipeline. Specifically, we examine how these drugs can help to drive client and customer affordability. A biosimilar is a medication that is highly similar to a biologic medication. Most biologics are specialty drugs. Although a biosimilar is not an exact copy – as seen for traditional, small molecule medications and their generic equivalents – there is no clinically meaningful difference between a reference product and its biosimilar(s).

A rapidly growing biosimilar market drives healthy competition and helps to create savings opportunities for those managing complex conditions. As approved biosimilars become available, we determine the lowest net-cost coverage option. We maintain a low net-cost drug strategy, putting more emphasis on preferring a biosimilar over the reference branded product.

Effective July 2021, the following medical specialty drug program enhancements will occur:

  • No longer preferring Remicade under the medical and pharmacy benefit to drive better customer and client affordability via biosimilars
  • Inflammatory and asthma therapeutic class actions to drive affordability
  • Additional utilization management actions and site of care guidance for certain medical specialty drugs

Less than 1% of customers will be affected by these changes.2 Affected customers (and their providers) will receive letters and emails in early April 2021 and reminders in May and July.

LEARN MORE:

  • To learn more about Cigna's biosimilar strategy, click here.
  • To access a flyer about Cigna's July 2021 formulary changes, click here.
  1. Cigna national book of business analysis, 2019.
  2. Cigna national book of business analysis of July 2021 clinical changes, 2021.

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