Outcome-based contract between CIGNA and Merck helps diabetics control blood sugar levels

The first national outcome-based contract between a pharmaceutical company and a pharmacy benefit management company (press release) resulted in an increase in the number of people with type 2 diabetes who were able to control their blood sugar levels by taking their medications appropriately. Extensive studies have shown that lowering blood sugar levels and increasing medication adherence results in better health for people who have diabetes. Blood sugar is generally considered under control when it is less than 8 percent.

“Because CIGNA is able to coordinate data and resources within our company, we are better able to support the health needs of the whole person”

The CIGNA (NYSE:CI) results demonstrated improved blood sugar levels of more than 5 percent for those continuously enrolled in the program regardless of which diabetes drug they were taking. Customers who actively participated in CIGNA's diabetes support program were 3 percent more likely to have their blood sugar under control than those who were not in the program. There was also a 4.5 percent increase in blood sugar lab testing during the period.

"Merck is pleased to partner with CIGNA on this program," said Sethu Reddy, M.D., MBA, FRCPC, FACP, MACE, vice president medical affairs, Merck. "As the number of people with diabetes continues to increase in the United States and globally, achieving blood sugar control and increasing adherence to diabetes treatment regimens are important goals for patients with type 2 diabetes and their doctors."

Medication adherence was 87 percent for people taking Januvia® (sitagliptin) and Janumet® (sitagliptin/metformin), Merck's oral anti-diabetes medications. The medications are used in conjunction with diet and exercise to improve blood sugar control in adults with type 2 diabetes, a condition that has reached epidemic proportions in the United States.

"Because CIGNA is able to coordinate data and resources within our company, we are better able to support the health needs of the whole person," said Dr. Jeffrey Kang, CIGNA's chief medical officer. "By integrating medical and pharmacy programs, we can identify people who may need extra support early in the diagnosis and progression of their diabetes, which means customers can potentially stay healthier longer."

Kang said CIGNA is uniquely positioned in the industry to successfully complete an outcome-based contract, and that this is the first of what the company expects will be many more such contracts with pharmaceutical manufacturers. "It's a key aspect of the future of pharmacy contracting," added Kang.

The two-part contract with Merck provided discounts if CIGNA customers with diabetes lowered their blood sugar levels, regardless of the medication they were taking, and also provided for additional discounts if people who were prescribed Merck's drugs Januvia and Janumet took their medications according to their physicians' instructions. Discounts will be shared in various ways with CIGNA employer clients.

Kang said that the idea of paying less for medications if they are successful is counter-intuitive and not at all like other performance-based contracts on the market today. What makes this unique approach so successful is that everyone's incentives line up behind helping customers keep their diabetes under control. CIGNA's costs are lowered, medication adherence increases, resulting in health benefits for individuals and improved productivity and lower health care costs for their employers.

The importance of helping people with diabetes take medications appropriately and monitor and control blood sugar levels cannot be over-estimated. According to a study published in the June 2005 edition of Medical Care, quality of life improves dramatically and estimated savings for individuals and employers could be up to $8,000 per person when medication adherence is between 80 and 100 percent. These savings are primarily due to reduced hospitalizations and emergency room visits.

CIGNA offers a range of programs that coordinate pharmacy, medical and behavioral clinical programs, including outreach to customers to support them in their journey to better health. Programs include:

CIGNA's Well Informed program identifies potential gaps, omissions, and errors in an individual's health care through analysis of medical, behavioral, pharmacy and lab data. When a gap is found, CIGNA contacts the individual and his or her doctor to inform them so that necessary adjustments to the individual's treatment plan can be made.

CIGNA Well Aware for Better Health^®, CIGNA's chronic condition support program, helps people who have chronic conditions such as asthma, diabetes, depression and weight complications better manage their conditions. Through this program, CIGNA offers access to a personal, experienced nurse and provides reminders about important tests and exams. Well Aware can help people with chronic conditions follow their doctors' plan of treatment, avoid complications and improve their quality of life.

CIGNA Pharmacy Management's CoachRx program involves reaching out to individuals who are not on track with their medication schedule. Online tools and pharmacy coaches are available to help people overcome challenges maintaining their medication schedule, change behaviors and, ultimately, improve their health.