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CIGNA Pharmacy Management

The Clinical Difference

Delivering Return On HealthSM Through Clinical Integration

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Health insurance expenses are the fastest growing cost component for employers. Unless

something changes dramatically, health insurance costs could overtake profits by 2008.

Source: McKinsey and Company


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The statistics are staggering…. . . Employer health insurance premiumsincreased by approximately twice the rate of inflation last year and show no signs of letting up.2

However, companies are finding relief from this problemby focusing on one component of their overall healthbenefit spend — their pharmacy benefit plan.

CIGNA is leading the way by improving

health trend.

By focusing on the total health of your employees, andhow they use their prescription drugs, CIGNA can reduceyour total health costs. It’s a solution that’s far moreeffective than simply managing drug trend. It’s an integrated approach that we call managing health trend —the annual cost of providing all health-related benefits.

What makes CIGNA unique is our depth and breadth of clinical expertise and focus. With more clinicians on staff than any other health insurer, our clinicalapproach improves patient outcomes to avoid high-costmedical treatments such as emergency room visits andhospital stays.

Undoubtedly, the integration of medical and pharmacybenefits achieves an ROI. But CIGNA’s holistic clinicalapproach elevates it to what we call giving our clients a Return On HealthSM (ROH).

A convincing formulaCIGNA Pharmacy Management can reduce overall health trend by as much as 50 percentwhen integrated with CIGNA HealthCare.3

The key word is “integrated.” By itself, CIGNA can reduce your drug trend by 5-10 percent versus other pharmacy benefit plans.4 Through integrated case management, clinical programs and access to medical,behavioral and dental programs, CIGNA can increase the likelihood that employees:

• Receive the right medications at the right time;

• Avoid unfavorable drug interactions and side effects; and

• Adhere to their therapy as prescribed.

Moreover, we can identify employees at risk for more serious conditions, help them obtain the care they needand improve their compliance with that care over time.

The Clinical Difference

Best-in-class clinical offering that achieves results

CIGNA engages and motivates members to take activesteps in the treatment of acute, chronic and complexconditions — steps that can lead to healthier outcomesand lower costs for them and their employers. At thesame time, we empower physicians to make decisionsbased on a more holistic view of their patients’ conditions than would otherwise be available to them.

The key to our ability is our on-staff clinical expertise.CIGNA has more clinicians than any other healthinsurer.5 More clinicians mean a stronger emphasis onholistic healthcare. Doctors, nurses, pharmacists — these professionals formulate and implement policy at ourmost senior levels. And they all work together to developintegrated programs that:

• Educate members about potentially beneficial andcost-efficient choices (for example, web tools);

• Provide incentives to make those choices (for example, coupon programs); and

• Encourage behaviors that lead to successful outcomesfrom both therapeutic and financial perspectives (for example, Step Therapy).

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CIGNA Pharmacy Management: Delivering ROH Through Clinical Integration

What does this mean to you?

By integrating clinical programs and case

management across medical and pharmacy and

implementing effective cost-management programs,

CIGNA improves clinical outcomes that lower your

overall healthcare costs and generate a greater

Return On Health.

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Outcome Improvement Programs:More than data — changingbehavior to improve outcomesand avoid unnecessarymedical costs

Americans are aging and taking more medications thanever before. Furthermore, they have more medications to choose from, with brand-name drugs, generics and therapeutic alternatives proliferating in the marketplace and drug companies marketing them directly to consumers.

CIGNA’s clinical programs can help employees avoid unfavorable drug interactions and side effects that can lead to increased medical expense and even hospitalization.By identifying gaps in care, our clinical programs helpemployees adhere to their prescription regimens toimprove their overall results, stay healthy and avoid additional medical and pharmacy costs. As their nameimplies, these Outcome Improvement programs aredesigned to help members treat conditions with greatersafety, efficacy and cost-efficiency.

Well Informed Program

Eliminates gaps in care across all member touchpoints

A recent study quantified what many plan sponsors have known all along. Prescription nonadherence costsemployers approximately $177 billion annually in preventable services and lost productivity.6 And only about 8 percent of United States consumers are awarethat their own nonadherence is an issue.7

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CIGNA’s Well Informed program focuses on the adherence issue and other gaps in care that can negatively affect desired outcomes and even exacerbatemedical conditions. Well Informed focuses on the chronic conditions most likely to benefit from disciplinedprescription therapy. These include asthma, diabetes, back pain and high cholesterol. Through clinical programsand case management, we determine whether members are adhering to prescriptions, filling prescriptions frommultiple sources and receiving immunizations and screenings. We also compare their history to evidence-based medical standards of care.

When a gap in care occurs, we communicate with boththe members and their physicians to:

• Guide members to appropriate action; and

• Alert the physician with information he or she needs to make decisions and communicate with patients.

Well Informed examines member’s integrated pharmacy,medical and other healthcare data on a monthly basis.The information it creates is timely and actionable. And depending on the nature and severity of the gap,information is transmitted to CIGNA Case Managers,pharmacists, chronic disease clinicians and health advisorsas a part of CIGNA’s Health Advocacy programs.

CIGNA knows that healthy employees are the backbone of a healthy business. Through our clinical programs thataddress medication adherence, we help your employeesachieve healthier outcomes so they can remain the valuable resources your business relies on.

Complex Psychiatric Case

Management Program

Reduces expensive medical costs and increases productivity

For too many employers, the problem is becoming all too familiar — increased absenteeism and decreased productivity because of employees with depression,anxiety and other behavioral disorders. In addition, these employees often account for the top 10 percent of employer medical expenditure8, with frequent emergencyroom visits and multiple psychotropic drug prescriptionsprescribed too often by multiple physicians.

CIGNA’s Complex Psychiatric Case Managment program is offered as an option with CIGNA Behavioral Health. It identifies employees who fill psychotropic drug prescriptions beyond specific thresholds and alerts theirprimary-care physicians or psychiatrists with personalizedpatient profiles. Physicians then have the informationthey need to consult with their patients and coordinatecare with other healthcare providers, if necessary. In addition, our Peer-to-Peer Counseling Service offers primary-care physicians the opportunity to consult with experienced psychiatrists for psychiatric referrals to help accelerate the healing process.

Narcotics Therapy Management Program

Identifies potential misuse and fraud

Healthcare costs for narcotics abuse are three times thosefor non-abusers. And with prescription drugs accountingfor 25-30 percent9 of all drug abuse in the United States,CIGNA developed its Narcotics Therapy Management program to identify potential abusers and empower their physicians to pursue the most effective courses oftherapeutic action.

The program focuses on narcotic analgesics, a leading prescription expense for many of our members. It integrates CIGNA medical and pharmacy data to identifypossible abusers and fraud perpetrators. Then CIGNAreaches out to prescribing physicians with informationthat provides them with evidence and resources to engagemembers in productive dialogues.

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CIGNA’s clinical management can improve member

outcomes by identifying gaps in care and addressing

adherence issues. By leveraging medical and pharmacy

data through proactive case management, CIGNA

equips physicians, pharmacists and members with the

information and on-going personal support they need

to take positive actions toward improving members’

health and reducing overall healthcare costs.



Cost Management Programs:Key driver to lowest net cost

CIGNA’s Cost Management programs generate a genericdispensing rate that ranks among the highest in the industry, at approximately 60 percent. They provide total PMPM savings that range from $2.25 to $2.30.10

However, when it comes to the interplay between member choice and employer cost, different plan sponsors havedifferent points of view. No sponsor, however, wants to compromise quality of care in the interest of savings.That’s why CIGNA’s Cost Management programs aredeveloped with the same clinical expertise that distinguishes our Outcome Improvement programs.

Save with Generics

Lets you capture savings from a $46 billionopportunity occasioned by brand-name drugscoming off patent by 201011

Never has there been a greater opportunity than now tolower prescription drug costs than by encouraging the useof generic drugs among your employees. CIGNA educates,engages and incents members and physicians to try generics and preferred brands. With one of the highestgenerics utilization rates in the industry, CIGNA hasproven its ability to lower your costs while maintaininghigh member satisfaction. Outreach programs include:

• Physician: CIGNA targets physicians to show them how much their patients would save by using generictherapeutic alternatives and encourages them to write prescriptions for alternatives, when appropriate.

• Member: Within one month after he has filled a brand-name prescription, CIGNA corresponds with the member to educate him about generics and urge him to discuss these lower-cost alternativeswith his physician.

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OTC Programs

Incents members to try lower-cost,over-the-counter alternatives

Over-the-counter (OTC) programs identify members whostand to benefit from OTC alternatives to prescriptiondrugs and offer them money-saving coupons for tryingalternatives. Currently, programs are available for PrilosecOTC® and Alavert®.

Step Therapy Program

Gradually encourages use of generics and lower-cost alternatives

CIGNA’s Step Therapy program gradually encourages theuse of generics in a way that reduces member disruption.

The program begins when a member requests a prescription for a brand-name drug that has generic therapeutic alternatives. Unlike many other pharmacy benefit plans, CIGNA fills the first prescription with abrand name if prescribed. Correspondence is sent to members and physicians about refilling with generics.Physicians are given the opportunity to authorize a brand drug if necessary.

By offering members an initial grace period and the ability to fill a prescription for a brand-name drug and then educating them on the merits of generics, membersare given ample time to transition to clinically-appropriate,lower-cost alternatives.

Currently, CIGNA offers Step Therapy for anti-ulcer, hypertension, high cholesterol and allergic rhinitis medications.

For healthier outcomes at an even lower cost…

. . . call CIGNA Tel-Drug, our state-of-the-art home delivery prescription drug program. Withtwo locations (Pennsylvania and South Dakota),Tel-Drug provides fast, efficient service.

Tel-Drug typically saves members the equivalent of a co-pay by ordering a 90-day supply of medication versus three refills at a local pharmacy.Refills are processed the same day they’re ordered.And accuracy is an astounding 99.995 percent, farhigher than that of any retail pharmacy.

Almost 30 percent of all CIGNA prescriptions arefilled through Tel-Drug; and, increasingly, many of them are for generic alternatives, thanks to Tel-Drug’s education outreach programs that alertmembers about less costly but equally effectiveoptions to their brand-name medications.

CIGNA Tel-Drug: Delivers cost savings for members and clients

1) Employers Memberssave save

2) Increased adherence through refill reminders and pharmacist consultations

3) Improved accuracy is

99.995% through automation

IncreasedGDR

largerdays’supply


Cost Management programs don’t have to limit

member choices. Our education-based programs

provide members and their doctors with the

information they need to determine whether they

should fill brand-name prescriptions with generic

therapeutic alternatives. We’re proud of the fact that

we’ve helped members adhere to their therapy

through equally effective, lower-cost options. And

we’re equally proud that we’re helping plan sponsors

reduce health trend while maintaining member choice.

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CIGNA Specialty Pharmacy:Balancing medication access toto deliver a Return On Health

Specialty pharmacy is the fastest growth area of pharmacyhealthcare. The Compound Annual Growth Rate for the2003-2008 period is estimated to be 20 percent, with the2008 CAGR forecasted to be $78 billion.12 The high cost of specialty drugs is becoming an issue for employers whoare faced with per-patient costs potentially reaching $1million annually.13

With a major increase expected in the number of biotechmedications available and an aging population, total specialty drug costs could rise considerably higher.

CIGNA’s Specialty Pharmacy solutions balance your needswith those of your employees and their dependents so thatcosts are managed, access to specialty medications is madeaffordable and positive therapy outcomes are maximized.

CIGNA’s integrated approach to managing specialty medications can help control your specialty pharmacycosts while improving member outcomes. Through integrated case management, CIGNA consolidates members’ medical, pharmacy, lab and behavioral healthcare to help members at risk of incurring highclaims costs better manage their conditions. This ability to integrate case management with the delivery and coordination of specialty medications in real time allowsclinical experts and trained support professionals to helpimprove medication adherence and promote healthiermember outcomes.

Our industry-leading clinical capabilities allow us to go far beyond the adjudication and fulfillment of specialtymedications to encompass how these medications areadministered and the role they play in members’ overalltherapy regimens. Better therapy management means less confusion and disruption of care, better health outcomes and lower plan costs. In the end, that means a better Return On Health.

CIGNA Pharmacy’s FinancialManagement and Service Model:Starts with a complete analysisof opportunities, behaviorsand goals

CIGNA offers numerous programs and cost structures fromwhich you can design your pharmacy management plan.The question is which combination of benefits and pricing offers the optimal solution for your business.CIGNA provides the right balance of quality care whilelowering health trend.

Just as CIGNA provides members with the educationaltools they need to make informed decisions, we offer plansponsors the ability to understand current employeebehaviors and structure their plans to accommodate thosebehaviors and perhaps change them over time. For example, what’s your current employee generic utilizationrate? Your formulary compliance rate? How much is yourplan spending on the chronic conditions that typicallyconstitute more than 50 percent of drug spend — asthma, depression and high cholesterol, to name but a few?

By understanding your employee claim patterns anddemographics, you can design a plan that offers the maximum opportunity for improved employee health atthe lowest net cost. And you can weigh this informationagainst the cost and employee choice variables that runthe flexibility spectrum from self-insured plans and steptherapy to the variety of integrated health outcome programs discussed earlier.

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One design does not fit all plans. We analyze

your employee demographics and claims history before

recommending a design specifically structured to

address the conditions most likely to influence your

overall health trend. As one of America’s oldest and

most respected insurance companies, CIGNA understands

risk. What’s more, we help you minimize your risk

by maximizing your Return On Health potential.


Whatever choices you make, however, you can be certainthat CIGNA provides you with:

Total Transparency

From a partner you can trust

CIGNA welcomes the move toward transparency. Ourapproach has always been to maximize savings for clients and members while providing the most clinicallyappropriate drugs for members. Through aggressive contracting strategies, member and physician educationand incentive programs, and clinical management, CIGNA provides a fully transparent approach to managingpharmacy benefits that you can count on.

CIGNA’s Pharmacy and Therapeutics Committee ischarged with analyzing new drugs to determine their safety and efficacy versus other alternatives. TheCommittee is comprised primarily of leading physiciansand pharmacists and focuses solely on clinical concernswhen issuing its recommendations.

Our formulary practices are representative of our commitment to transparency in everything we do. Thatmeans an approach to client and member savings thatdoes not rely on rebates. We are proud of the certificationof transparency we have received from the HumanResources Policy Association, an organization comprised of senior human resource executives representing nearlyevery major industry group in the United States economy.

Comprehensive Service

Empowers you to measure your ROH

Your CIGNA Pharmacy Clinical Account Manager isdedicated to helping you define objectives for your plan,design it accordingly and track your progress over time. In fact, the vast majority of our Account Managers arelicensed pharmacists with an extensive background inbenefits management and a keen understanding of howpharmacy benefits can be used to improve member healthoutcomes and decrease client cost.

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You can depend on your Account Manager to help youevaluate CIGNA’s quarterly and annual performancereports that provide in-depth views of plan activities.You’ll gain important insights on:

• What’s really driving your plan’s cost;

• Which therapeutic conditions demand special focus; and

• Where the opportunities to optimize utilization and adherence may be found.

The technology behind our reporting function is designedto capture and analyze the rich data available from ourintegrated approach to improving health trend. We combine pharmacy data with lab results, diagnoses,emergency room visits and other medical information toprovide you with a total portrait of where you stand andwhat you have to do to achieve your members’ health andcost objectives.

Member Communications that Educate,Engage and Empower

CIGNA’s clinical programs all feature extensive memberoutreach components that engage members at specifictrigger points and motivate them to take positive action.Central to our member communications efforts ismyCIGNA.com, our secure member website that offers awide variety of online tools to facilitate member decisions.

myCIGNA.com provides members with access to their personal claims history, as well as an overview of the benefits to which their plan entitles them. OurPrescription Drug Price Comparison Tool enables members to:

• Search for specific drugs and price them out at Tel-Drug or any of the more than 57,000 retail pharmacies in CIGNA’s nationwide network;

• Order prescriptions and refills directly from CIGNA Tel-Drug; and

• Determine whether a generic equivalent or other therapeutic alternative to the specified drug is available and, if so, compare pricing.

myCIGNA.com also, offers money-saving coupons, with incentives for members to consider generics. And educational alliances with well-known medical information providers enable quick reference to medication characteristics and comparisons.

Is your current pharmacy benefit plan generating a Return On Health?

We think you should consider a plan that does.

Return On Health = CIGNA Pharmacy Management

It’s a powerful formula that can be quantified. And as youwould expect, it’s a formula that we can substantiate.

With roots that go back to 1792, CIGNA is one ofAmerica’s oldest and most respected employee benefitplan providers. Our heritage is insurance and our ability to manage risk prudently serves our clients well.

Because CIGNA assumes much of the risk inherent inpharmacy management and other healthcare plans, we areacutely aware of the need to minimize your risk as muchas possible.

In an industry that sometimes produces commoditizedprograms, CIGNA stands out with its clinical focus andunique approach to controlling health trend. For moreinformation, contact your CIGNA representative and findout how you can achieve a higher Return On HealthSM

for your employees and your business.

1 F. Lichtenberg, “Are the Benefits of Newer Drugs Worth Their Cost?Evidence from the 1996 MEPS.” Health Affairs. Sept/Oct 2001: 5:241-251.

2 The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2006Annual Survey.

3 CIGNA Actuarial Sourcing and Underwriting. 4 CIGNA Best Total Results collateral piece, page 2. 5 “How Consumerism is Changing the Health Insurance Industry—Q&A

with David Cordani.” Strategy+Business. March 27, 2007. www.strategy-business.com/li/leadingideas/li00019?tid=230&pg=all

6 National Council on Patient Information and Education. Newsvine Report:“Skipping Doses Could be Deadly. “www.newsvine.com/_news/2007/07/30/867467

7 EW Boehm et al. Rx Adherence Hits the Ignorance Wall. Forrester. April 2006.

8 “Patient Compliance: A Problem that Plagues the Healthcare Industry.”Pharmacy Times. April 7, 2006.

9 DA Reiger, WE Narrow, DS Rae, et al. “The defacto US mental and addictive disorders service system: Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services.” Archives of General Psychiatry. 1993; 50:85-94.

10 CIGNA Commercial Book of Business as of 1/1/07.11 Pharmacy Benefit Management Market Overview — 2007. (A BusIntel

Report). KnowledgeSource. April 2007.12 Citigroup Industry In-Depth Report on PBMs. May 10, 2007 13 “Specialty drugs to drive future health costs.” Benefit News.com.

www.benefitnew.com/pfv.cfm?id=8064.

Alavert is a registered trademark of Wyeth Consumer Healthcare and Prilosec OTC is a registered trademark of Proctor & Gamble.

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CIGNA Pharmacy ManagementCIGNA900 Cottage Grove RoadHartford, CT 06152

www.CIGNA.com

“CIGNA Pharmacy Management” is a registered service mark, and "Return on Health" is a service mark, of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries.“CIGNA Pharmacy Management” refers to operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of CIGNA Health Corporation.

© 2007 CIGNA Pharmacy Management. All rights reserved.

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