Guiding to the ideal sites of care for medical specialty pharmacy

The decision is too important to take lightly. Choosing where to receive treatment with a medical specialty drug will have impacts on multiple levels. These complex drugs are often injected or infused by a health care professional. The setting where this takes place should offer high quality service. It should be within reasonable proximity to the customer’s home. Final costs also shouldn’t be double or even triple those of rival care settings.

That’s where Cigna's Specialty Care Options program focuses its efforts. It works to ensure that when costly specialty drugs need to be administered, they are given in clinically appropriate and convenient settings. This process has saved our clients approximately $81,000 per successful intervention, per year1 and approximately $250 million for just 3,025 customers.2

Care settings are not all created equal.
Many specialty medications must be injected or infused. The actual process of administering these drugs can take place in a variety of care settings. However, costs can vary widely from one location to another. Often, the most costly site of drug administration is an outpatient facility. Meanwhile, the most cost-effective option is often at a doctor’s office, infusion suite, or even a customer's home, supervised by a home health nurse. We help oversee a smooth transition to the preferred site of care, all while offering educational support and identifying and closing gaps in care.

At the heart of Specialty Care Options is a team of medical directors, pharmacists, case manager nurses, and care associates. They review each specialty medication request and target those for drugs administered in a high-intensity setting. They evaluate the customer’s condition and needs, and then work with customers and providers to identify the ideal site of care for treatment. All the while, they help to make sure customers continue to receive quality care and service.

What sets our approach apart is that we manage site of care proactively – often before the customer has even their first injection. We include site of care review as part of the prior authorization process. This allows us to help prevent the use of a costly site of care before a visit even takes place.

Changing the site of care from a hospital to the doctor’s office could mean a 50% savings.3
Specialty Care Options helps customers and clients save by making over 100 drugs eligible for site of care management.* A recent addition to the list is Neulasta – a drug given the day after chemotherapy to help stimulate the growth of "healthy" white blood cells in the bone marrow. We added this drug to our site of care steerage efforts in September 2020. Results to date show $39,000 in savings per redirected case for this drug alone.2 Administration costs at a hospital setting are often more than double the cost of equal service offered in a physician’s office setting, for example.2

Integrated benefits equal better line of sight.
Cigna's integrated specialty approach means that we help manage costs and care across benefits. We can help customers and employers better understand the true total cost of care. With our complete view across benefits and ability to leverage our provider network, Cigna is able to manage site of care as appropriate. Preferred providers match up with our high standards for customer affordability and convenience. A standalone pharmacy benefit manager (PBM) may have limited alternate site of care options.

Talk to your Cigna representative or click here to learn more.

*As of February 2021

  1. Cigna claims analysis 2020. Includes both retrospective and prospective programs results. Individual customer results/costs will vary.
  2. Cigna’s nationwide Book of Business projected savings analysis 2020. Individual customer results/costs will vary.
  3. Express Scripts research. Specialty Medications Specialty Medications Nearing 50 Percent of Spend, 11/27/2018. http://lab.express-scripts.com/lab/insights/specialty-medications/specialty-medications-nearing-50-percent-of-spend.

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