Inflammatory and Atopic Conditions facts
The human body will sometimes confuse its own tissue or cells as being harmful, and the subsequent inflammatory response actually creates harm. Chronic inflammation can lead to conditions like rheumatoid arthritis, Crohn’s Disease, psoriasis, ulcerative colitis and others1.
Atopic conditions are chronic and often lead to other conditions. For example, 80% of patients with atopic asthma also manage atopic dermatitis, food allergies or allergic rhinitis2.
What is the Inflammatory + Atopic Conditions Care Value Program?
The Inflammatory + Atopic Conditions Care ValueSM Program, part of the SafeGuardRx® platform, is focused on managing specialty drugs for patients with inflammatory and/or atopic conditions at the indication-level.
This strategy enables price competition among clinically equivalent medications, and in turn, helps control plan costs while ensuring patients have access to the best treatment for their specific condition.
Member Benefits
Enhanced care support
Individualized counseling and adherence monitoring from specialist clinicians for patients filling through Accredo® Specialty Pharmacy.
Improved therapy access
Segment therapy options by indication within each disease class, which lowers drug costs and assures that patients are getting the right drugs at the right time.
Plan Benefits
Manage treatment options
Avoid unnecessary waste and spend by ensuring only the right patient gets the right medication at the right time. Indication-level management refines utilization by indication, which segments classes and sets treatment preferences for each disease category, enabling patients and physicians to select drugs by disease, not therapy class.
Rigorous clinical documentation ensures the best therapy option is filled and patients get the medications that they need.
Financial protection
Early discontinuation reimbursements per 30-day prescription for the first three fills of preferred inflammatory and/or atopic conditions medications for new-to-therapy patients.
Program-specific requirements apply.
Cost savings
Additional discounts on select atopic conditions medications.
Frequently Asked Questions
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What was the decision process for the drugs preferred/blocked within the program?
As with all programs, clinical comes first. Drugs are reviewed by an Evernorth® independent National Pharmacy and Therapeutics (P&T) committee for clinical appropriateness.
Based on the recommendations from the P&T committee, clinically equivalent medications are then reviewed from an affordability perspective by the Value Assessment Committee (VAC). This is the same process that we leverage for formulary development.
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Why are drugs included in the Inflammatory + Atopic Conditions Care Value Program managed at the indication level over therapy class?
This strategy enables price competition across clinically equivalent medications; in turn helping control plan costs while ensuring patients have access to the best treatment for their specific condition. Rigorous clinical documentation ensures the best therapy option is filled and patients get the medications that they need.
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How will new drugs, such as biosimilars, roll into the Inflammatory + Atopic Conditions Care Value Program?
We will review each new drug, including biosimilars, upon approval for its inclusion in the Inflammatory + Atopic Conditions Care Value Program.
- Medical News Today. Everything you need to know about inflammation.
- American Academy of Pediatrics. Burden of Atopic Dermatitis.