Evernorth Announces New Era of Pharmacy Benefit Services to Lower Americans' Medication Costs

Rhea-AI Summary

Evernorth (NYSE:CI) unveiled a new rebate-free Express Scripts pharmacy benefit model on Oct 27, 2025 to lower drug costs, improve price transparency, and boost support for local pharmacies.

The plan promises an average 30% reduction in monthly brand-name prescription costs for people who pay full price, automatic selection of the lowest available price at the pharmacy counter, and clinical safeguards including thousands of safety checks. Cigna Healthcare will adopt the model for fully insured lives in 2027; it becomes standard for all Evernorth pharmacy clients in 2028. New pharmacy reimbursement takes effect across in-network pharmacies in 2026.

Positive

• Average 30% reduction in brand-name costs for full‑pay patients
• Automatic lowest-price selection at pharmacy counters
• Cigna Healthcare adoption for fully insured lives in 2027
• Standard offering for all Evernorth pharmacy clients in 2028
• New pharmacy reimbursement model rolling out across networks in 2026

Negative

• None.

Insights

Health benefits strategist

Evernorth unveils a rebate-free, transparent pharmacy benefit with pledged upfront discounts and pharmacy reimbursement changes.

Under the new Express Scripts model, discounts negotiated with drug manufacturers become visible at purchase, bypassing post-sale rebates and aiming to lower brand-name drug costs by an average of 30% at the pharmacy counter for members who pay full price. The plan promises automatic price comparison logic that charges the lowest of the Evernorth-negotiated price, cash discount, direct-to-consumer price, or copay, and notes an example where a customer would pay $20 under that logic.

The company will roll out elements on a clear timeline: broader consumer benefit access in January 2026, Cigna Healthcare adoption for fully insured lives in 2027, and availability to all Evernorth pharmacy clients in 2028; the new pharmacy reimbursement model starts across in-network pharmacies in 2026. Key dependencies include actual price realization at pharmacies, merchant adoption of the automated price-comparison technology, and pharmacy acceptance of the new cost-plus-plus dispensing reimbursement and quality-based payments.

Watch measurable adoption and outcome signals over the next 12–36 months: enrollment counts using the rebate-free option, average out-of-pocket reductions for brand drugs (reported as 30% in the announcement), and the share of in-network pharmacies participating under the new reimbursement terms. These milestones will indicate whether the announced mechanics deliver the promised transparency and cost reductions while supporting local pharmacies.

Unveils Transparent Rebate-Free Pharmacy Benefit; Lower Costs and Better Experience for Americans; Greater Support for Local Pharmacies

BLOOMFIELD, Conn., Oct. 27, 2025 /PRNewswire/ -- Evernorth, the health services division of The Cigna Group (NYSE:CI) today announced a new rebate-free pharmacy benefit model designed to help Americans stay healthy and get the medications they need by lowering costs, improving transparency, and supporting local pharmacies so care is always within reach.

"While pharmacy benefit managers have already helped the U.S. achieve the lowest prices for generics in the world – which account for 90% of all prescriptions – the cost of brand-name medicines remain out of reach for too many Americans. We applaud President Trump and his Administration for taking decisive action to help lower costs for brand-name medicines that have long been controlled by drug companies," said David M. Cordani, Chairman and CEO, The Cigna Group. "We are building on our long track record of pharmacy benefits innovation to put Americans first – lowering their drug costs, protecting access to their trusted pharmacies, and providing the clinical support and safety checks they need to stay healthy."

Evernorth's new Express Scripts pharmacy benefit services model is rooted in three core components:

Transparent, rebate-free pharmacy benefit services
Evernorth will transition toward a new model where discounts negotiated with drug companies are available upfront to Americans buying their medications. This new approach will cut out the complex post-purchase rebate process by making the discounted price of the drug readily available and transparent from the start.

For Americans, this means lower costs – particularly for brand-name drugs – at the pharmacy counter, as they will directly benefit from the discounts Evernorth secures. For businesses and other health plans, this means a simpler, more direct path for procuring medications for their benefit plans. It also gives them more real-time visibility into their drug costs, improving their ability to support their population and forecast their budgets.  

"Pharmacy benefit managers have successfully driven down costs for Americans with generics and now with biosimilars. President Trump has highlighted the urgent need to tackle the high list prices of the 10% of medications that make up 88% of costs," said Adam Kautzner, PharmD, President of Evernorth Care Management and Express Scripts. "In this new era of pharmacy benefits, we're creating more choice for Americans by lowering the costs of expensive brand-name drugs while driving accelerated adoption of generics and biosimilars. Our innovative model is a win-win for Americans and their employers—lower costs for Americans, real-time transparency for employers, and renewed trust in pharmacy benefits for all."

Cigna Healthcare will adopt this model for its fully insured lives beginning in 2027. It will become the standard model available for all Evernorth pharmacy benefits clients beginning in 2028. 

Lower costs and better experiences for Americans
For Americans in health plans where they pay the full cost of medications, including millions of people with high-deductible plans, this new model will reduce their monthly cost for a brand-name prescription by an average of 30%.

Evernorth is also ensuring Americans pay the lowest available cost for both brand-name and generic medicines – whether it is the Evernorth negotiated price, their copay, or a cash discount price. To do that, Evernorth leverages technology to automatically compare multiple pricing options and charge the lowest cost at the pharmacy counter. For example, if a medicine has:

• An Evernorth negotiated cost of $22 (70% off the list price),
• A cash discount cost of $20,
• A drug company's "direct-to-consumer" cost of $50, or
• A copay of $25;

the customer will pay $20, the lowest of the four options. In most cases, the Evernorth-negotiated cost is the best, but there are instances where the cash discount cost is lower, particularly for Americans in high-deductible health plans. Tens of millions of Americans benefit from this technology today and millions more will start benefitting in January 2026. Evernorth plans to integrate this model with new direct-to-patient programs when they become available to ensure the lowest costs are always widely available to Americans.

By helping Americans use their pharmacy benefit to get the lowest price on medications, Evernorth ensures that their out-of-pocket costs count toward their annual deductible. Americans also receive the protection of Evernorth's robust clinical safeguards, which include thousands of safety checks that help prevent harmful drug interactions, flags allergies, and ensures medications are taken correctly. More than 50% of patients prescribed chronic care medications do not follow their treatment plans consistently, which makes Evernorth's clinical support essential to appropriate medication use and helping Americans achieve better health.

Customers will also have the option to pay Evernorth's negotiated cost rather than the drug company's list price if a prescribed brand-name medicine is not covered by their health plan – giving customers more choices for how they get their medicines.

Support for community pharmacies so medications and care are always within reach
For many Americans, their local pharmacy is the front door to health care and an essential part of their care team. To ensure local pharmacies can continue to play this critical role, Evernorth is adopting a new reimbursement model that compensates pharmacies based on their cost for medications plus a dispensing fee and additional reimbursement for the essential clinical services they provide to patients.

This forward-thinking approach to clinical reimbursement will recognize and reward pharmacies for the broad range of care services they provide, extending beyond dispensing medications. By setting higher quality standards, pharmacies will have the opportunity to earn additional reimbursement for delivering exceptional patient care and achieving improved health outcomes.

The new reimbursement model will be implemented across all in-network pharmacies starting in 2026, ensuring that every local pharmacy has the resources and incentives to excel in patient care and service.

This new pharmacy benefit model builds on the company's decades-long legacy of driving affordability for millions of Americans. From pioneering the use of generics to expanding access to biosimilars, it has consistently led the way in lowering prescription drug costs while ensuring customers have the support and guidance they need to use their medicines correctly. Evernorth is proud to continue its tradition of innovation with this breakthrough new model that improves affordability, access, and health for millions of Americans.

About Evernorth Health Services 
Evernorth Health Services creates pharmacy, care, and benefits solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention, and treatment of illness and disease more accessible to millions of people. Evernorth capabilities are powered by our businesses, including Express Scripts, Express Scripts® Pharmacy, Accredo, eviCore, and MDLIVE, along with holistic Evernorth platforms and solutions that move people and organizations forward. All Evernorth solutions are serviced and provided by or through operating affiliates of Evernorth Health, a wholly owned subsidiary of The Cigna Group (NYSE: CI), or third-party partners. Learn more at evernorth.com.

Media Contact: 
Justine Sessions
Justine.sessions@evernorth.com
860-810-6523

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SOURCE Evernorth

FAQ

What change did Evernorth announce for pharmacy benefits on Oct 27, 2025 (CI)?

Evernorth announced a rebate-free pharmacy benefit model that makes negotiated discounts visible upfront and automatically charges the lowest available price at the pharmacy counter.

How much will Evernorth's new model lower brand-name prescription costs for full‑pay patients?

Evernorth says the model will reduce monthly costs for brand‑name prescriptions by an average of 30% for people who pay the full cost.

When will Cigna Healthcare and other Evernorth clients start using the new Express Scripts model (CI)?

Cigna Healthcare will adopt the model for fully insured lives in 2027; it becomes the standard option for all Evernorth pharmacy clients in 2028.

Will Evernorth's new pricing count toward patient deductibles (CI)?

Yes. Evernorth says the lowest negotiated price charged at the counter will count toward the patient's annual deductible.

What changes will pharmacies see under Evernorth's new reimbursement model in 2026?

Starting in 2026, in‑network pharmacies will be reimbursed for medication cost plus a dispensing fee and additional payment for eligible clinical services.

When will more Americans start benefiting from Evernorth's automatic price comparison technology?

Evernorth says tens of millions benefit today and that millions more will begin benefiting in January 2026.