Tag Archives: cigna

DPO Approves CINGA-Express Scripts Merger

The action brings together a major health insurer and a pharmacy benefit manager that some analysts say should help control costs by merging drug and medical benefits management.

To date, Cigna and Express Scripts have obtained clearances from departments of insurance in 16 states. The companies are working constructively with regulators in the remaining jurisdictions to obtain clearance for the merger. Cigna and Express Scripts continue to anticipate that the deal will close by year-end 2018, subject to the satisfaction of all closing conditions.

CIGNA to merge with Express Scripts

Cigna Corp (CI.N) shareholders on Friday voted in favor of the health insurer’s proposed $52 billion acquisition of pharmacy benefit manager Express Scripts Holding Co (ESRX.O), although the deal still needs clearance from antitrust authorities.

The U.S. Department of Justice is still conducting an antitrust review of the combination that is not expected to close until later this year.

According to the preliminary results, about 90 percent of the votes cast were in favor of the merger, the health insurer said.

Cigna expects the merger to close by end of 2018.

CIGNA Opioid-related formulary changes

A communication is being sent to impacted Cigna clients in the next few days to announce updates on our July 2018 formulary changes.

Pharmacy costs are currently the number one driver of client expenses under both pharmacy and medical benefits.1 At the same time, opioid abuse continues to be a U.S. public health crisis according to the Department of Health and Human Services.2 To address these issues, Cigna’s formulary strategy will be updated to maintain high clinical value while continuing to use a low net drug cost approach to manage coverage for costly branded drugs. At the same time, we will build upon current steps to administer prescription drug coverage in a manner that promotes safe opioid use.

Effective July 2018* our formularies will be updated and Cigna will implement tighter utilization management around the use of opioids.

Customers (employees and dependents) affected by these changes (estimated to be less than 1% of customers3) will also receive a letter from Cigna in early April informing them of the change. Depending on the change, the letters contain steps to work with their doctor to find covered alternatives, prescribe lower quantity levels or apply for drug coverage approval through Cigna’s prior authorization process.

  • Click here to read a summary of Cigna’s July 2018 formulary changes.

Click the following links to view detailed (drug specific) changes for each of Cigna’s formularies. Clients will be sent the above summary and one of the flyers below based on their formulary:

CIGNA to acquire ExpressScripts

After CVS agreed to acquire insurer Aetna, CIGNA has agreed to purchase express scripts for $67 billion.  Express Scripts is the largest pharmacy benefit manager (PBM) in the country.  This continues the remake of the nations healthcare system through merger and acquisition:

 

“Aetna and CVS have said they hope to create “front doors” to healthcare through 9,800 stores run by CVS. That deal could turn many of the chain’s stores into one-stop-shop locations for an array of healthcare needs like blood work and eye or hearing care, in addition to their traditional role of filling prescriptions.

UnitedHealth Group Inc., which runs the nation’s largest insurer, is spending almost $5 billion to buy nearly 300 primary and specialty care clinics and some urgent care and surgery centres. That push will help the company steer patients away from expensive hospital care.

Another insurer, Humana Inc., is making a separate deal to better manage the care of its Medicare Advantage patients.”

CIGNA NY Fined $2,000,000 by Insurance Department

DFS SUPERINTENDENT VULLO ANNOUNCES $2 MILLION FINE AGAINST CIGNA FOR VIOLATIONS OF NEW YORK INSURANCE LAW

DFS Investigation Discovered That Cigna Illegally Sold Stop-Loss and Fully Insured Health Insurance Policies Outside of New York to New York-Based Small Groups

Cigna Cherry-Picked Risks, Undermining the Integrity of New York’s Health Insurance Market

Financial Services Superintendent Maria T. Vullo today announced that the Department of Financial Services (DFS) has fined Cigna Health and Life Insurance Company $2 million for violations of New York State Insurance Law involving the illegal sale of stop-loss insurance and unapproved health insurance policies that would otherwise have been part of New York’s small-group market.  Stop-loss insurance may be sold only to large group employers that self-fund underlying medical expenses in order to mitigate liability for losses that result from an unexpected amount of claims.  In a consent order entered into with Cigna and announced today, DFS found that Cigna improperly sold stop-loss and fully insured health insurance policies outside of New York to New York-based small groups with employees in New York State, and where, in many cases, the companies solicited business and conducted other activity in the state.

“By deliberately choosing to write New York risks outside of New York, Cigna’s actions harmed New York’s community-rating program for small group employers,” said Superintendent Vullo.  “Cigna cherry-picked risks, which may have improperly induced forum shopping in the New York small-group market.  DFS will continue to protect New York consumers and take appropriate enforcement action against any company that engages in unfair trade practices to undermine New York’s health insurance market.”

After receiving complaints about Cigna’s practices, DFS requested that Cigna immediately cease selling the illegal stop-loss policies pending a DFS inquiry.  The company initially agreed but later resumed selling the policies in question.  DFS also became aware that Cigna was issuing fully insured health insurance coverage outside of New York to New York-based small groups based on the fact that those small groups were incorporated outside of New York but where, in many cases, the companies’ solicitation and other activity occurred in New York.

Cigna, based in Connecticut, is licensed as a life insurance company in New York, and is authorized to write life, accident, and health insurance in New York, including stop-loss insurance.  Cigna does not have fully insured health insurance coverage products approved to sell to small groups in New York.

A targeted examination by DFS found that Cigna sold 81 group health insurance policies in violation of New York Insurance Law, including 38 stop-loss insurance policies to New York small groups seeking to self-insure and 43 fully insured health insurance policies to small groups as if they were selling to non-New York small groups.

A copy of the consent order can be found here.

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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