Evernorth, the health services division of The Cigna Group, has officially announced the launch of a first-of-its-kind pharmacy benefit offering, which is designed to make weight loss medications WEGOVY® and ZEPBOUND® more accessible for patients.
According to certain reports, the company will leverage direct negotiations with the medications’ manufacturers to achieve its affordability objectives.
Taking a deeper view of all the benefits this initiative might bring for patients, we begin from its promise to offer lower monthly copays than cash programs. This translates to how the monthly copay for GLP-1 weight loss medicines will be limited to no more than $200, something which is expected to have an added benefit of counting towards the patient’s annual deductible.
Such a reduction, like you can guess, will also empower patients to save more, as they can now save as much as $3,600 per year, compared to buying these medications directly from manufacturers or through consumer programs.
Next up, there is potential for enhanced safety and efficacy. We get to say so because, by availing WEGOVY® or ZEPBOUND® through Evernorth’s pharmacy benefit, patients won’t just be able to benefit from FDA-approved medications, but they will also be supported through Express Scripts’ robust safety checks designed to reduce negative or adverse drug interactions.
Another detail worth a mention is rooted in a simplified approval and access mechanics. Here, Evernorth will conceive prior authorization processes to dramatically simplify, as well as automate the proceedings for a faster access.
Beyond that, patients can also come expecting the option to choose from a broad network of local retail pharmacies or home delivery through Evernorth’s EnGuide Pharmacy, staffed by clinicians with specialized knowledge in GLP-1s for enhanced support.
“We are reimagining pharmacy benefits to reduce costs and better serve patients,” said Adam Kautzner, Pharm D, President of Evernorth Care Management and Express Scripts. “This is what Express Scripts does better than anyone: save Americans money on their prescriptions while helping them achieve their health goals.”
Turning our attention towards the kind of benefits Evernorth will deliver for employers and other health plan sponsors, it will bring, just like on the patient side of things, significant cost reduction. You see, health plan sponsors will see a significant reduction in the net cost per prescription of GLP-1 medications.
Beyond that, they can also access a facility to actively help patients in accessing medication which works best for them, and they can do so without compromising affordability or clinical safety.
Among other things, we ought to mention how the development in question marks the expansion of Evernorth’s already-extensive suite of GLP-1 solutions.
This particular suite, in case you weren’t aware, offers EncircleRx, which happens to be a financial model with more than 9 million enrolled lives. The stated model has, markedly enough, saved health plans $200 million dollars since 2024. Apart from that, the suite also has available a solution called EnReachRx, a high-touch patient support clinical model for dispensing GLP-1 prescription medications.
Operating out of St. Louis, Evernorth’s rise up the ranks stems from making the prediction, prevention, as well as treatment of illness and disease more accessible to millions of people. The company’s excellence in what it does can also be understood once you consider it has, thus far, worked alongside Express Scripts, Express Scripts® Pharmacy, Accredo, eviCore, MDLIVE, and various other big names.
“As advocates for the millions of people we serve, we drive lower medication costs through negotiations with the pharmaceutical manufacturers, and we’re making it easier than ever for health plan sponsors to cover GLP-1s for weight loss,” said Harold Carter, PharmD, senior vice president of trade relations at Express Scripts. “This is how we deliver on our promise to put patients first – by making innovative medicines more accessible, at a lower cost, while providing patients and physicians choices in this fast-evolving market.”
