Cigna’s Switch from CareCentrix to Wholly-Owned eviCore May Impact Network Access for IVIG Providers

In February 2020, Cigna announced that it would be terminating its contract with CareCentrix, the third party administrator that had managed home infusion therapy services for Cigna’s beneficiaries nationwide.  The announcement indicated that the termination would take effect on February 1, 2021.  In its place, Cigna indicated that it would be using eviCore – a wholly-owned subsidiary of Express Scripts (and, in turn, Cigna) – as its new third party administrator for home infusion therapy services.

The announcement indicated that eviCore will become Cigna’s utilization management subcontractor assisting members with non-specialty infusions, and that eviCore will provide home health, all home infused medications, and durable medical equipment services for Cigna customers.  Cigna advised that providers must be contracted with eviCore before February 1, 2021 to be considered an in-network provider.

In so doing, however, many home infusion providers were notified that they would no longer be given access to the same scope of therapies in their new contracts with eviCore, as compared to the scope of services covered under the agreements with CareCentrix.  Instead, certain therapies – including Intravenous Immunoglobulin (IVIG) – would now need to process (virtually exclusively) through Cigna’s specialty pharmacy, Accredo.  In addition to not being offered a contract that includes IVIG services, several providers reported that patients began to receive letters indicating that they could no longer receive services from their home infusion provider, and directing them to transfer their prescriptions to Accredo.

While Cigna stated that the transition to Accredo from CareCentrix will “help promote affordability of medical benefit drugs and ensure quality of care,” it appears that many independent providers will likely be negatively impacted.  Indeed, for home infusion providers, providers may find they are no longer able to service Cigna patients as of February 1, 2021.    

How Frier Levitt Can Help

Fortunately, however, there are several options for home infusion providers facing potential network exclusion.  These options may help mitigate the negative effects of the transition from CareCentrix to eviCore, and provide opportunities for IVIG providers to continue to service their patients.  Home infusion providers that have been provided notice of this benefits change, or who have faced network exclusion should contact us today.  Frier Levitt assists home infusion providers on a variety of issues, including maintaining network access.

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