Evernorth expands diabetes program with enhanced coverage for continuous glucose monitors

Cigna's Evernorth subsidiary is expanding its diabetes care value program to combine traditional pharmaceutical interventions with devices, tools and resources to help patients better understand and manage their diabetes.

Diabetes is a complex chronic condition that affects more than 37 million Americans. Another 96 million adults are considered prediabetic, according to the Centers for Disease Prevention and Control. Managing diabetes also can be overwhelming and costly to employers and plan sponsors.

According to the American Diabetes Association, $237 billion in medical costs is attributed to diabetes spend each year with $90 billion in lost productivity due to diabetes each year.

Evernorth's diabetes care value program will now include coverage for the use of continuous glucose monitors (CGMs) under the pharmacy benefit. CGM integration enables greater convenience and provides key clinical data about a patient’s glucose levels.

Where there are specialty medications that are available for treatment, diabetes is a broad disease process that requires a comprehensive approach to help patients manage the condition, said Christine Gilroy, M.D., Express Scripts’ chief medical officer and vice president of clinical strategy.

"We see the need for us to really be in the space and look at developing programs that weave a blanket for the spectrum of diabetes. It's not just those individuals with type 2 diabetes on some of the specialty medications. It's insulin access and then it’s the additions that we're making to the program currently with continuous glucose monitors," Gilroy said in an interview.

CGMs are typically covered as durable medical equipment under the medical benefit but that frequently includes a high copay, Gilroy noted.

"For those individuals who are type 1 diabetics or brittle type 2 diabetics, it really makes it difficult to afford what can be a very protective and life-saving intervention," she said.

She added, "We're working to expand the breadth and depth of the blanket that we’re weaving and adding in the continuous glucose monitors in addition to some of the adherence guarantees for specialty type 2 medications. We're also broadening the patient support that we offer through our therapeutic resource center."

Launched in 2017, Evernorth's diabetes care value program aims to support people living with diabetes and those at risk for the disease to help manage their health, and help blunt the costs associated with diabetes for patients and plan sponsors. 

Cigna rebranded its health services business line as Evernorth back in 2020. Evernorth includes a slew of Cigna segments, including pharmacy benefit manager Express Scripts and specialty pharmacy Accredo.

As part of the expanded diabetes care value program, Evernorth also is rolling out predictive analytics to enable proactive outreach to eligible patients and their providers to support shared decision-making surrounding the potential benefit and use of a CGM.

"We're using the data that we have on 110 million covered lives across the United States to delve into identifying those individuals that are on medications that indicate that they are brittle or otherwise at-risk and would benefit from a continuous glucose monitor," Gilroy said. "It's about really engaging in advance and identifying those individual individuals who could benefit from continuous glucose monitor support."

Evernorth's diabetes care value program also includes a preferred quality pharmacy network that can lower costs and improve adherence, National Preferred Formulary or utilization management tools to drive to the lowest net cost diabetes medications, and reimbursement opportunities when patients fall off therapy, according to the company. 

Members who enroll in the program also have access to digital diabetes prevention and obesity solutions and digital care for type 1 and type 2 diabetes to send CGM results to clinicians who analyze the data and provide meaningful coaching interventions.

Express Scripts' diabetes therapeutic resource center also offers specialized support for members around medication education and counseling to improve adherence to treatments. Staffed by pharmacists and other diabetes experts, it enables the organization to "check-in" on patients through text messages and other engagement, Gilroy said.

"The therapeutic resource centers were developed in order to help manage adherence and side effects for expensive and impactful medications. We work to educate members about the medications and educate them about the risk of discontinuing the medications or the need to connect to a different medication. We also advocate for them with their prescribers," she said.

She added, "In some instances, we even go into the home and do home delivery services for some of these medications."

The diabetes program is part of Evernorth's slate of SafeGuardRx programs that focus on a spectrum of chronic conditions. As health conditions are often interconnected, the program’s comprehensive approach supports improved outcomes across a spectrum of chronic conditions. The diabetes care value program helped an additional 16.9% of enrolled patients at risk for heart disease and stroke start statin therapy, according to the company. If all plans were to similarly increase statin use, nearly 20,346 heart attacks would be prevented over the next 10 years, Evernorth estimates.