The message is familiar, but grows louder as time goes on: Specialty spend is continuing to grow at a rapid pace. In fact, by 2023, it’s estimated that over two-thirds of new drug launches will be Specialty therapies, many indicated for rare diseases and cancer.1
At Cigna, we strive every day to make health care simpler and more affordable. We help customers to push back against the upward trend of costly Specialty medications. We accomplish this by educating customers about available third-party financial assistance programs and then helping them to secure assistance through these programs.
For customers who use Accredo®, our Cigna specialty pharmacy, coordination of financial assistance is a key piece of the Therapeutic Resource Center® (TRC) model.
There are 15 TRCs available to Cigna customers, each focused on a specific medical condition – examples include asthma, oncology, human immunodeficiency virus (HIV), and multiple sclerosis. Each is equipped with a team of specialty-trained clinicians. They bring a wealth of knowledge that’s concentrated on each medical condition. They also understand that patient out-of-pocket cost is a common – and critical – barrier to Specialty medication adherence.
Customer financial worries may include unpaid bills, how they’ll manage time away from work during recovery from surgery, or how they’ll be able to pay for and remain adherent to all their prescribed medications. That’s why the TRCs work with customers to identify, coordinate and address the need for financial assistance.
In 2021, TRC financial assistance coordination helped customers achieve about $1.7B in copay assistance.2
This support includes proactive outreach to new customers as well as to existing customers who are either new to therapy or on an existing therapy. An Accredo representative will explain what copay assistance programs may be available through manufacturers, charitable foundations or other sources. About 98% of Specialty medications at Accredo have a manufacturer or third-party assistance program available to those who qualify.2 Customers are not only made aware of available copay assistance, but also about how to maximize it. In some instances, a mixture of copay assistance sources may be simultaneously available to a customer.
For many customers, the Accredo representative will handle the copay assistance enrollment process on their behalf, if given authorization from the customer to do so and pending the requirements of the third-party financial assistance program. The Accredo representative will also routinely reach out to any available charitable foundation while the customer is still on the phone, in order to guide them through the funding registration process and ensure they get the help they need. The Accredo representatives also have the capability to see real-time alerts when new charitable foundation resources or funds become available, so they can quickly pass the information along to appropriate customers and encourage their application process to begin right away.
SaveOnSP* also helps connect customers to manufacturer copay assistance programs, but helps clients save too – about $4 or more per member per month (PMPM).3
Most Specialty medication manufacturers have a copay assistance program designed to help customers save on costs. SaveOnSP helps customers access these available funds.
Since Specialty medications come with a hefty price tag, the customer may have a small copay, but the plan would have to cover the rest. SaveOnSP works in alignment with the Affordable Care Act and designates some medications as non-essential health benefits. With this change, copays for these drugs adjust to match the maximum monthly amount of copay assistance allowed by the manufacturer. This lowers customer copayments to zero and the employer portion of the cost shrinks too.
We connect with every customer who takes a medication on the SaveOnSP drug list to make them aware of this opportunity.
Out of Pocket Adjuster helps minimize the impact of copay assistance on plan design.
Manufacturer copay assistance programs can help customers afford expensive Specialty medications, but left unmanaged, they can also drive up costs for clients. Our Out of Pocket Adjuster solutions helps them to save money. It ensures that only what the customer pays goes toward their deductible and out-of-pocket maximums so they won’t meet their maximum as quickly.
It works through these steps:
Please contact your Cigna representative and access these resources:
* SaveOnSP copay to be offset by copay assistance, resulting in $0 member cost. Program cost is 25% of the maximized savings – limited drug list and client restrictions apply. Client opt in, must have Exclusive Specialty with zero grace fills, excludes: Insured clients, HSA plans (IRS guidance for first dollar coverage), Private exchange plans, EGWP, IFP, IFP Indemnity plans, and grandfathered plans, standalone pharmacy clients and global. In general to be eligible for coverage a drug must be prescribed by a health care professional, purchased from Accredo, be covered under the pharmacy benefit, and be medically necessary.
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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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