- Kaiser Permanente and Cigna's health services business, Evernorth, have negotiated a new agreement giving Kaiser's more than 9 million commercial members access to providers contracted with Cigna when they travel outside of Kaiser's service areas and need emergency or urgent care.
- Under the agreement, which starts in August and lasts for five years, Kaiser members will be responsible for the cost-sharing within their plan, and not have to pay out-of-network rates for visiting Cigna providers outside of the eight states covered by Kaiser.
- In addition, Evernorth's specialty pharmacy, Accredo, will be Kaiser's preferred external pharmacy for certain drugs, while Evernorth's CuraScriptSD will be a preferred distributor for certain other specialty products. The partnership could extend to other areas during its five-year term, the companies said.
The deal, which does not apply to Kaiser's Medicare and Medicaid members, is meant to provide convenient care access for Kaiser's beneficiaries when they travel, a Kaiser spokesperson said.
It's Kaiser's first partnership to use a rival insurer's network, but not the first for Cigna. In 2020, the payer linked up with insurtech startup Oscar Health to jointly sell commercial health plans to small employers leaning on Cigna's provider network.
The partnership won't change Cigna's guidance for 2022, but is an example of the company's ability to partner with other competing entities, Cigna told Credit Suisse regarding the deal.
Cigna launched Evernorth in 2020, folding its pharmacy benefit management arm Express Scripts and other services businesses like specialty pharmacy and medical benefit management into the new division. Cigna has used Evernorth to explore new ways to drive revenue through its capabilities, both internally and with other third parties.
Under the partnership, Evernorth is replacing Kaiser's current pharmacy benefits manager, MedImpact, for its specialty pharmacy business for specific limited distribution drugs. It doesn't represent all of Kaiser's specialty business.
MedImpact's full PBM contract with Kaiser is up for renewal in 2023.
Spokespeople for Evernorth and Kaiser said financial terms of the deal are not being disclosed.