December 2017

Generic statins added to PPACA No-Cost Share Preventive Formulary

On November 1, 2017, low to moderate intensity generic statins must be made available to customers between the ages of 40 to 75 at no cost. This new requirement was based on recent guidance issued by the U.S. Preventive Services Task Force, whose members provide recommendations on which drug classes should be covered under Patient Protection and Affordable Care Act (PPACA). Under PPACA, the health care reform requirements state that non- grandfathered health plans make certain preventive medications available to (non-Medicare) customers at no cost-share ($0).1

The impact of this new mandate is expected to be widespread, as statins are significantly used to lower cholesterol and prevent cardiovascular disease.

Client and customer impact

  • Starting on a client’s renewal date on or after November 1, 2017, low to moderate intensity generic statins will be made available to customers between the ages of 40 to 75 at no cost-share.
  • It is estimated that close to 100% of Cigna’s client base (all non-Medicare segments) will be affected starting November 1, 2017.2
  • Although the financial impact will vary by client, it is estimated to be approximately $0.25 per member per month.2
  • Clients who already offer a $0 preventive program to their customers will not be impacted by this change as drugs that treat cholesterol are already part of their benefit plan.
  • This requirement will not affect name brand statins. Customers filling a preferred or non- preferred brand statin will continue to pay their brand cost-share.
  • Grandfathered plans will not be impacted by this change.

Details of the changes to Cigna’s No Cost PPACA preventive formulary

To address this requirement, Cigna is in the process of adding the following drugs to our No Cost  PPACA preventive formulary. These medications have been identified as low to moderate intensity by the American College of Cardiology/American Heart Association (ACC/AHA).

Moderate-Intensity Statin Therapy

Low-Intensity Statin Therapy

Daily dose lowers LDL-C, on average, by approximately 30% to less than 50%3

Daily dose lowers LDL-C, on average, by less than 30%3
  • Atorvastatin 10-20 mg
  • Rosuvastatin 5-10 mg
  • Simvastatin 20-40 mg
  • Pravastatin 40-80 mg
  • Lovastatin 40 mg
  • Fluvastatin XL 80 mg
  • Fluvastatin 40 mg (twice a day)
  • Simvastatin 10 mg
  • Pravastatin 10-20 mg
  • Lovastatin 20 mg
  • Fluvastatin 20-40 mg

Note: Simvastatin 5mg and 80mg are excluded from PPACA logic because of lack of effectiveness and high risk for adverse effects respectively.

  1. The no-cost share preventive coverage enacted under the Affordable Care Act remain in effect at this time for non-grandfathered health plans. Should health care reform change, we will review the guidance at that time.
  2. 2017 National book of business Cigna analysis. Actual costs will vary depending on plan type and utilization.
  3. Chart includes targeted low-to-moderate intensity statin medications as well as statistics defined by the American College of Cardiology/American Heart Association (ACC/AHA).