Evernorth Launches New Benefit Option That Drives Lower Net Cost for Weight Loss Medicines and Limits Patient Cost to No More Than $200 Per Month
Rhea-AI Summary
Evernorth, The Cigna Group's (NYSE: CI) health services division, has launched a groundbreaking pharmacy benefit offering for weight loss medications WEGOVY® and ZEPBOUND®. Through manufacturer negotiations, patient monthly costs will be capped at $200, potentially saving patients up to $3,600 annually compared to direct-to-consumer programs. The cost will count toward patients' annual deductibles.
The program features simplified authorization processes, access to retail pharmacies or home delivery through EnGuide Pharmacy, and enhanced safety measures. For health plan sponsors, the initiative promises significant reductions in net prescription costs while maintaining patient choice. This adds to Evernorth's GLP-1 solutions suite, which includes EncircleRx (saving health plans $200 million since 2024) and EnReachRx for patient support.
Positive
- Monthly costs for WEGOVY® and ZEPBOUND® capped at $200, saving patients up to $3,600 annually
- Copayments count toward patient's annual deductible
- Significant reduction in net prescription costs for health plan sponsors
- EncircleRx program has saved health plans $200 million since 2024
Negative
- None.
News Market Reaction
On the day this news was published, CI declined 1.39%, reflecting a mild negative market reaction.
Data tracked by StockTitan Argus on the day of publication.
- Patients can save as much as
$360 0 - New offering helps employers meet growing demand for FDA-approved weight loss medications at a lower net cost per prescription while ensuring clinical safety for patients
"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."
This initiative fills a critical need in the market by offering savings, choice and predictability to both patients and health plan sponsors.
Benefits for Patients:
- Lower Monthly Copays than Cash Programs: The monthly copay for GLP-1 weight loss medicines will be limited to no more than
$200 - Meaningful Savings: Patients can save as much as
$3,600 - Enhanced Safety and Efficacy: By accessing WEGOVY® or ZEPBOUND® through Evernorth's pharmacy benefit, patients will benefit from FDA-approved medications and Express Scripts' robust safety checks designed to reduce negative or adverse drug interactions.
- Simplified Approval and Access: The prior authorization processes accompanying the new offering will be simplified and automated for faster access.
- Choice of Pharmacies: Patients can select 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.
Benefits for Employers & Other Health Plan Sponsors:
- Significant Cost Reduction: Health plan sponsors will see a significant reduction in the net cost per prescription of GLP-1 medications.
- Offering Patient Options: Health plan sponsors can ensure that patients have access to the medication that works best for them, without compromising affordability or clinical safety.
"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."
Evernorth has the most extensive suite of GLP-1 solutions available with this new addition, which also includes:
- EncircleRx, a financial model with more than 9 million enrolled lives that has saved health plans
$200 million dollars - EnReachRx, a high-touch patient support clinical model for dispensing GLP-1 prescription medications.
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 is Cigna's (CI) new cost limit for WEGOVY and ZEPBOUND prescriptions?
How much can patients save with Cigna's new weight loss medication program?
What benefits does Cigna's new GLP-1 program offer to employers?
How has Cigna's EncircleRx program performed since 2024?
What pharmacy options are available under Cigna's new weight loss medication program?
