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We are pleased to announce that effective April 1, 2019, Cigna will begin to offer coverage for Continuous Glucose Monitors (CGMs) under the pharmacy benefit, for those members who use them to consistently manage blood glucose levels. Therapeutic CGMs include three components that work together to monitor glucose levels: A sensor, a transmitter, and a reader/receiver. Dexcom G6® and Abbott FreeStyle Libre are the only therapeutic CGMs currently on the market. Previously, CGMs had been covered under the medical benefit.
What this means to you Coverage
for CGMs under the pharmacy benefit is available to any of your clients that currently use Cigna Pharmacy Benefit Management - whether or not they access the Cigna medical network - provided they do not exclude coverage for the devices. We expect most clients and members will experience improved savings when filling therapeutic CGMs under the pharmacy benefit instead of the medical benefit.
What is changing: - Through this new program, members with Cigna Pharmacy can fill their CGM prescription through their pharmacy benefit plan.
- The transmitter and reader/receiver components will be offered by the manufacturer at no cost when provided by the pharmacy (processed outside of the benefit plan).1
- Members
can fill their prescription for CGMs at any in-network pharmacy, including Cigna Home Delivery Pharmacy.
- Prior authorization (PA) and quantity limit (QL) edits apply per members' existing plan.
- Members can still maintain coverage for CGMs under their medical plan, but the new option offers them an alternative that may reduce their costs.
- This change applies to Payer Solutions clients that have Cigna Pharmacy even if they currently access a medical network other than Cigna for their medical benefit.
Informing your members - what you need to do You
may wish to share news of this coverage expansion with your clients and members. For your reference, we have attached a copy of a sample member letter. Please note: Cigna will not be informing your members, because we do not have information about those members currently accessing CGMs under their medical benefit.
We have included additional information about GGMs below. If you have any questions or concerns about this formulary change, please do not hesitate to reach out to me.
Thank you,
Francine Taylor, R.Ph. MBAMarket Manager, Payer Segment Cigna Pharmacy Management Office: 860-902-4916 Cell: 614-981-5209
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Additional background on CGMs More than 100 million U.S. adults are living with diabetes or prediabetes, according to the Centers for Disease Control and Prevention (CDC)2 - resulting in $327 billion in total medical costs and lost productivity each year.3 By offering more affordable coverage for glucose monitoring technologies, we are hoping to help control the escalation of this prevalent and expensive trend, improve member access and enhance client and member affordability to these devices, when clinically appropriate. Although
not for every person managing diabetes, for members with more challenging diabetes, therapeutic CGMs can improve care in many ways.4 - Convenience
- Checking glucose is faster than with a blood glucose meter.
- The CGMs are filled immediately at the pharmacy (also can be filled by Cigna Home Delivery Pharmacy) just like traditional test strips.
- Easy and actionable
- CGMs continuously monitor glucose levels, allowing a person to take action quicker.
- CGM systems are inserted once over a 10- to 14-day period and gather actionable data, day and night, without disruption to daily activities or sleep, as compared to finger sticks, which generate a single glucose level reading.
- The
reader/receiver is preprogrammed with the individual's glucose goals, tracks trends, and some can alert of hyperglycemia or hypoglycemia. A reader/receiver does not require calibration for accuracy.
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1. Cigna, while administering coverage for products described herein, is not responsible for the operation of the manufacturers' programs. 2. CDC report: More than 100 million Americans have diabetes or prediabetes, press release July, 2017. 3. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017; Diabetes Care 2018 Mar; dci180007. 4. Recent survey by Diabetes in Control Data: (Piper Jaffray diabetes survey (n=339) from Feb 13�26, 2018 consisting of patients, physicians, nurses and CDEs).
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Cigna Payer Solutions - 2019 Cigna. Some content provided under license. |
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