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Memo Date
RFP# 260125 – PBM RFI Benefit Design Network Plan:Confidential, unpublished property of The Cigna Group. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2025 The Cigna Group
Benefit Design
| Category |
| Question |
| Response |
| Formulary Type |
| Standard/Closed, Open, Managed, Value Driven, Custom |
| Standard |
| Drug Exclusion Lists |
| Exclusion of high cost low value drugs |
| Preventative Lists |
| List and/or attach any preventative or other drug lists currently in place |
| DIABETIC SUPPLIES ONLY-Generic and Preferred Brands |
| Clinical Utilization Management |
| Prior authorization, quantity limits, step therapy |
| Essential-Non-Specialty |
Standard-Specialty
| ERISA vs Non-ERISA |
| ERISA or Non-ERISA |
| Non-ERISA |
| Specialty |
| Exclusive or Open |
| Exclusive Specialty |
| Specialty Optimization |
| Manufacturer Assistance, Charitable, International |
| Yes |
| Biosimilar Strategy |
| Include a description of clients current biosimilar strategy |
| Weight loss coverage |
| List whether weight loss is covered and/or any wellness programs |
| No |
| Diabetes Management Programs |
| List any diabetes management programs |
| Diabetic supplies only |
| Custom |
| Describe all custom benefit design and/or programs |
| None |
| Member Cost Share |
| Member cost share by tier and by channel |
| Cost Share by Tier |
| Deductible |
| Deductible (Yes or No) |
Pharmacy only or combined with medical No
| Network |
| Retail Network (Broad or Narrow) |
90 Day Retail Network (Broad or Narrow) Mandatory Mail Mandatory Mail Specialty Retail Network-Broad
90 Day Narrow
Mail Specialty-0 fills
| Programs |
| List ALL active programs and associated fees. Attached description of each active program. |
| SaveOn, PAP, Preventive Diabetic Supplies $0 cost |
HSA Plan:
Benefit Design
| Category |
| Question |
| Response |
| Formulary Type |
| Standard/Closed, Open, Managed, Value Driven, Custom |
| Standard |
| Drug Exclusion Lists |
| Exclusion of high cost low value drugs |
| Preventative Lists |
| List and/or attach any preventative or other drug lists currently in place |
| DIABETIC SUPPLIES ONLY-Generic and Preferred Brands |
| Clinical Utilization Management |
| Prior authorization, quantity limits, step therapy |
| Essential-Non-Specialty |
Standard-Specialty
| ERISA vs Non-ERISA |
| ERISA or Non-ERISA |
| Non-ERISA |
| Specialty |
| Exclusive or Open |
| Exclusive Specialty |
| Specialty Optimization |
| Manufacturer Assistance, Charitable, International |
| Yes |
| Biosimilar Strategy |
| Include a description of clients current biosimilar strategy |
| Weight loss coverage |
| List whether weight loss is covered and/or any wellness programs |
| No |
| Diabetes Management Programs |
| List any diabetes management programs |
| Diabetic supplies only |
| Custom |
| Describe all custom benefit design and/or programs |
| None |
| Member Cost Share |
| Member cost share by tier and by channel |
| Cost Share by Tier |
| Deductible |
| Deductible (Yes or No) |
Yes Combined with Medical
| Network |
| Retail Network (Broad or Narrow) |
90 Day Retail Network (Broad or Narrow) Mandatory Mail
Retail Network-Broad
90 Day Narrow
Mail Specialty-0 fills
| Programs |
| List ALL active programs and associated fees. Attached description of each active program. |
| PAP, Preventive Diabetic Supplies $0 cost |
HRA Plan:
Benefit Design
| Category |
| Question |
| Response |
| Formulary Type |
| Standard/Closed, Open, Managed, Value Driven, Custom |
| Standard |
| Drug Exclusion Lists |
| Exclusion of high cost low value drugs |
| Preventative Lists |
| List and/or attach any preventative or other drug lists currently in place |
| DIABETIC SUPPLIES ONLY-Generic and Preferred Brands |
| Clinical Utilization Management |
| Prior authorization, quantity limits, step therapy |
| Essential-Non-Specialty |
Standard-Specialty
| ERISA vs Non-ERISA |
| ERISA or Non-ERISA |
| Non-ERISA |
| Specialty |
| Exclusive or Open |
| Exclusive Specialty |
| Specialty Optimization |
| Manufacturer Assistance, Charitable, International |
| Yes |
| Biosimilar Strategy |
| Include a description of clients current biosimilar strategy |
| Weight loss coverage |
| List whether weight loss is covered and/or any wellness programs |
| No |
| Diabetes Management Programs |
| List any diabetes management programs |
| Diabetic supplies only |
| Custom |
| Describe all custom benefit design and/or programs |
| None |
| Member Cost Share |
| Member cost share by tier and by channel |
| Cost Share by Tier |
| Deductible |
| Deductible (Yes or No) |
Yes Combined with Medical
| Network |
| Retail Network (Broad or Narrow) |
90 Day Retail Network (Broad or Narrow) Mandatory Mail
Retail Network-Broad
90 Day Narrow
Mail Specialty-0 fills
| Programs |
| List ALL active programs and associated fees. Attached description of each active program. |
| SaveOn, PAP, Preventive Diabetic Supplies $0 cost |
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