Evernorth Optimizes Access to Weight Loss Medications with New Pricing Initiative

Evernorth Optimizes Access to Weight Loss Medications with New Pricing Initiative

In a significant move aimed at enhancing patient access to high-cost GLP-1 weight loss medications, Evernorth—the health services division of Cigna—has announced a groundbreaking pharmacy benefit offering. Currently, only about half of Cigna's clients cover popular weight loss drugs like Wegovy and Zepbound due to their high prices. However, this new initiative is set to transform that landscape.

The newly established pricing agreement with drug manufacturers Eli Lilly and Novo Nordisk caps the monthly out-of-pocket costs for patients at $200. Harold Carter, Evernorth’s senior vice president of pharmacy relations, emphasized that this solution targets employers currently hesitant to cover these medications due to financial concerns. By reducing the costs for plan sponsors while providing predictable out-of-pocket expenses for members, this initiative aims to expand coverage significantly.

Currently, those with Evernorth insurance may only pay co-pays as low as $25 per month for these medications. The new cap of $200 will represent a considerable reduction compared to the cash prices available directly through the drug manufacturers' websites. In fact, estimates suggest that patients may save up to $3,600 annually compared to direct-to-consumer programs.

The agreement also simplifies the pre-authorization process for accessing these medications, allowing patients to obtain their prescriptions either at retail pharmacies or through Evernorth's home delivery service at the established capped price.

For clients already offering these weight loss drugs, Evernorth expects to deliver up to a 20% reduction in their costs with this new arrangement. While Cigna has not disclosed the exact discounts from the deal, analysts estimate that large employers and other insurers are likely to see discounts between 30% and 50% off the list price for these medications, positioning this initiative as a potentially game-changing development in the pharmacy benefits landscape.

As part of this strategic push, last month CVS Caremark announced it would designate Novo’s Wegovy as its primary weight loss drug, effectively sidelining Eli Lilly’s Zepbound, signaling a shift in market preferences. Meanwhile, while Novo Nordisk did not comment on the new arrangements, leaders at Eli Lilly have stated their ongoing commitment to making Zepbound more accessible to patients battling obesity.

The financial implications of these new pricing arrangements could be further compounded by pending government negotiations for Medicare discounts on Ozempic and Wegovy, scheduled to take effect in 2027. As these drugs are likely to be preferred in Medicare programs, it could create competitive pricing pressures that benefit employers and insurance sponsors alike.

Evernorth's new pricing program is expected to officially begin in the second half of the year, as employers prepare to finalize coverage options for the upcoming annual benefits cycle. This initiative not only marks a pivotal moment in addressing the affordability of obesity medications, but also highlights the growing trend towards value-based arrangements in healthcare, aiming to balance cost-control with improving patient access to essential medications.

In summary, Evernorth’s innovative pharmacy benefits initiative is set to redefine the availability and affordability of crucial weight loss medications, potentially reshaping how obesity treatment is accessed in corporate healthcare plans.