CIGNA Merck Outcomes-Based Pharmacy Contract

Statement of Problem, Need or Support: Can a non-traditional pharmacy contract be implemented that focuses on outcomes for the patient rather than market share.

Target Audience/Population: CIGNA Customers (Members)

Objectives for Project or Solution: To align all of the incentives of the health care system behind improving health and lowering costs.

Implementation Plan or Methodology, Resources, Metrics: The companies spent close to nine months reviewing innovative alternatives to traditional discount agreements and identifying what outcomes to measure and how. In the end, they selected type-2 diabetes for the pilot because effectively managing blood sugar levels and increasing medication adherence are measureable metrics. CIGNA's pharmacy and medical condition support programs to help people with diabetes take their medications as directed were an important element of the contract.

Results, Evaluation: CIGNA and Merck economists reviewed the data and verified the results which were as follows:

• Blood sugar levels improved by more than 5 percent.
• Individuals who participated actively in CIGNA’s diabetes support program were more likely to control their blood sugar than those not in the program. 
• 87 percent of people taking Merck’s Januvia and Janumet took their medications correctly (80-100% is considered ideal and been shown to improve health and lower costs).
• Customers who actively participated in CIGNA's diabetes support program were 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.
• Savings could be as much as $8,000 per person for those who take their medications properly.