Special Programs

In our continuing effort to help you and your employees manage pharmacy costs, CIGNA offers specialized pharmacy programs that help treating providers improve safety and outcomes for members and/or offer savings opportunities for everyone.

Complex Psychiatric Case Management – Working with CIGNA Behavioral Care, CIGNA Pharmacy Management offers a program that focuses on providing integrated data to primary care and/or psychiatric physicians to assist with:

• Educating prescribers on patient adherence and consumption of psychotropic medications, and help
• Physicians foster the appropriate level of care among members.

Narcotics Therapy Management – Designed to help reduce prescription drug fraud and abuse and facilitate treatment for substance abuse, this program facilitates provider awareness of prescription utilization patterns for narcotic analgesics.

Prior Authorization/Step Therapy – Based on FDA guidelines, clinical research and evidence, this program promotes cost-effective therapy by creating a sequence, or "steps" in the choice of medications used to treat certain ongoing medical conditions. Drug treatment is started with a "first step" medication, generally a generic, before moving to higher-cost medications, if medically necessary. Generic drugs have the same quality, strength, purity and stability as brand-name drugs, yet are typically less expensive.

A physician can request a second or third step medication be covered for medical reasons by completing a prior authorization request. Typically, medications listed on the CIGNA HealthCare prescription drug list as "Preferred Brand" would be available as a "second step", and medications listed as Non-Preferred Brands would be on the "third step". The "first step" medications do not require prior authorization. The out of pocket expense (coinsurance and/or copay) typically is higher for second or third step medications.