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CIGNA Focuses the Power of Pharmacy Management to Reduce Medical Costs for Individuals and Employers


Evidence-Based Medicine is the Key

BLOOMFIELD, Conn. - Focusing the expertise of its pharmacy management capabilities, CIGNA (NYSE:CI) has been able to dramatically improve health outcomes and reduce medical costs for individuals enrolled in various clinical programs the company offers.

Since 2004, CIGNA has reported on the savings it has been able to achieve through its Outcome Improvement Programs, which encourage customers to take their medications appropriately to achieve better health. The most recent findings from 2008 demonstrate that millions of dollars in medical costs can be avoided by adhering to evidence-based medicine and the appropriate use of prescription medications. The 2008 findings include:

A 74 percent medication adherence rate resulting in 50 percent of the people in the cholesterol program reaching their cholesterol goals, a 78 percent decrease in LDL (bad cholesterol) levels, with 262 heart attacks avoided annually for a $6.6 million savings in over-all medical costs for individuals in the program.

A 34 percent increased use of medications used to control asthma which meant fewer emergency room visits and hospitalizations due to the condition. The result was a 50 percent reduction in medical costs for people in the program.

A medication adherence rate of 84 percent for people with diabetes, with 19 percent reaching their hemoglobin A1C (blood sugar) goals. Hospitalizations were reduced by 18 percent and emergency room visits by 13 percent, with an over-all medical cost reduction of 24 percent. These results led the company to develop the first outcome based contract with a pharmaceutical manufacturer. (CIGNA and Merck Sign Performance-Based Contract)

A 35 percent increase in the completion of depression treatment plans, which studies show means fewer instances of relapse, resulting in an 18 percent reduction in medical and behavioral health care costs.

“Pharmacy benefit management companies that have a narrow view of only managing prescription medications miss the opportunity to help improve people’s over-all health outcomes, which has been shown to reduce the much larger expense…total medical costs,” said Eric Elliott, president of CIGNA Pharmacy Management. “By working to improve the health of our customers through the coordinated use of prescription drugs, medical disease management, and behavioral coaching, we have been able to deliver, and document, significant over-all medical cost savings.”

By working with CIGNA behavioral health experts, newer programs, such as narcotic therapy management and complex psychiatric case management, realized savings per individual from $2,200 to $2,750 for the six month period following the pharmacy intervention. Total savings for employers in the program was $27.1 million. While the program was pharmacy related, notably, 70 percent of the savings came from medical cost reductions such as emergency room visits, outpatient costs and hospitalizations.

Prescription drugs account for between 25 to 30 percent of all drug abuse in the United States and an estimated 31 million Americans have used painkillers without a medical need.1 “These programs are part of our concentrated effort to encourage evidence-based medicine to find and stop abuse before it destroys lives. Even one employee with an abuse problem is a risk to both their employer and their health,” added Thom Stambaugh, chief pharmacy officer for CIGNA.

CIGNA also demonstrated that use of CIGNA Tel-Drug Home Delivery Pharmacy in conjunction with a retail pharmacy, instead of using a retail pharmacy only, resulted in an 11 percent improvement in medication adherence. In one case study, the client achieved an 18.4% improvement in medication adherence, reducing medical costs by $350,000 for the study group. If everyone in this pilot group had the same medication adherence as the CIGNA Home Delivery Pharmacy group, the medical cost savings opportunity would have exceeded $1 million. The conditions that demonstrated the greatest savings in medical costs included diabetes, high cholesterol, hypertension and depression because people with these conditions tend to use more medical services.

CIGNA has seen significant results in specialty pharmacy, the fastest growing health care cost, as well. Review of medications at the time prescriptions were being filled yielded savings for people with multiple sclerosis, without incurring additional medical costs, which is an indication that the lower cost alternatives worked just as effectively for those individuals.

Each month CIGNA evaluates evidence-based medical and pharmacy omissions, gaps, and errors in care for the individuals it serves. When issues are identified, CIGNA reaches out to those customers and their physicians. Nurse case managers, behavioral health experts, pharmacists and health coaches work with the customers to address their needs. The value of the savings is based on national data that determines the average difference in emergency room, in-patient hospital admission rates and prescription medications used by these people pre and post intervention.

“The ability to achieve these results is tied to our success in evaluating data to identify issues related to an individual’s medical care and the use of prescription drugs, ranging from fraud and abuse to not taking needed medications appropriately. Through the collective involvement of CIGNA’s pharmacy, medical and behavioral specialists, we are able to engage the individual through targeted programs to address that person’s specific needs,” said Dr. Doug Nemecek, national medical director for CIGNA. “We are able to achieve these results because of our integrated medical, pharmacy, and behavioral approach.”


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