Cigna uses predictive risk modeling to identify patients likely to benefit from aggressive LDL-C lowering statin treatment

In a move that is intended to foster access to cholesterol-lowering therapy for patients who will best benefit, Cigna has entered into a first-of-its-kind contract with AstraZeneca to help ensure that patients are given an appropriate cholesterol-lowering medication based on their treatment needs.

For Cigna patients who are at increased risk for atherosclerotic cardiovascular disease (ASCVD) and need to aggressively manage their low-density lipoprotein cholesterol (LDL-C), rosuvastatin calcium (Crestor, AstraZeneca), a cholesterol-lowering drug can be prescribed and filled without requiring prior authorization.

“This program facilitates access to prescription therapy for customers who are identified as high risk,” said Jon Maesner, PharmD, Cigna's chief pharmacy officer. 

Specifically, for our customers who are enrolled in benefit plans that include prescription step therapy requirements, Crestor is subject to a generic first-step edit,” Dr Maesner explained. “In this program, customers will have access to Crestor without going through step therapy if they are at high risk of cardiovascular event defined by clinical factors in predictive risk modeling. Customers who meet a predetermined risk threshold will be exempt from the generic step edit.”

There is a direct and real-time application of individualized predictive health risk to the access of prescription benefits to benefit customers, according to Dr Maesner. 

"The uniqueness of this program lies in the power of integrated health information applied real-time in prescription benefit administration,” Dr Maesner said.

Crestor is indicated as an adjunct to diet to reduce elevated Total-C, LDL-C, ApoB, non-HDL-C, and triglycerides, and to increase HDL-C in adult patients with primary hyperlipidemia or mixed dyslipidemia and to slow the progression of atherosclerosis in adult patients as part of a treatment strategy to lower Total-C and LDL-C to target levels. It is also indicated to reduce the risk of myocardial infarction, stroke, and arterial revascularization procedures in patients without clinically evident coronary heart disease but with an increased risk of cardiovascular disease (CVD) based on age (men ≥50 and women ≥60), high-sensitivity C-reactive protein (hsCRP) ≥2 mg/L, and the presence of at least one additional CVD risk factor, such as hypertension, low HDL-C, smoking, or a family history of premature coronary heart disease