Dive Brief:
- Cigna’s Evernorth has reached new deals with manufacturers Eli Lilly and Novo Nordisk to cap patients’ copays for pricey GLP-1 weight loss medications, the health services business announced Wednesday.
- The agreements cap monthly out-of-pocket costs for Zepbound and Wegovy at $200 for participating patients. They also more deeply discount the drugs for employers and health plans that contract with Evernorth for prescription drug plans, by up to 20% per prescription, according to a spokesperson.
- The savings are available to Evernorth clients through a new benefit option that could incentivize more payers concerned about the financial burden of the drugs to cover the medications.
Dive Insight:
Pharmacy middlemen like Cigna subsidiary Evernorth have been trying to make GLP-1s more accessible for their health plan and employer clients and the patients they cover.
Currently, steep list prices have placed the medications out of reach for many Americans. Despite sky-high demand and increasing acceptance of GLP-1s for a greater variety of conditions, including obesity, fewer than one in five employer-sponsored plans covered GLP-1s for weight loss in 2024. Many cite cost as the limiting factor.
Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound, for example, are listed at about $1,350 and $1,060 per month respectively before any discounts, according to the Institute for Clinical and Economic Review. (Though, the specific amount a patient actually pays depends largely on their drug plan — after negotiated savings, the monthly net cost of Wegovy falls to about $620 and that of Zepbound falls to $725.)
Evernorth’s new program caps members’ costs at $200 per month and reduces GLP-1 prices for their plan sponsor. It also includes a simpler prior authorization process and allows patients their choice of pharmacy, whether that’s a local retail pharmacy or Evernorth’s home delivery option.
Consumers can save up to $3,600 each year through the program compared to buying the drugs directly from manufacturers or through other patient assistance programs, Evernorth said.
The benefit could nudge more Evernorth clients to cover GLP-1s. Currently, only half of its employer clients cover drugs like Wegovy and Zepbound for weight management, executives said on a call with investors earlier this month.
The new benefit is the latest in a suite of Evernorth programs built around expanding access to GLP-1s tied to financial guardrails and clinical oversight. The health services company’s first such play, EncircleRx, has grown since its launch in early 2024 to cover more than 9 million people.
More recently, Evernorth announced two new programs meant to improve clinical care around the dispensing of GLP-1s and provide home delivery of the medications.
Evernorth’s newest benefit follows a recent deal struck by rival pharmacy benefit manager CVS Caremark with Novo Nordisk to give Wegovy preferred access on Caremark’s standard formulary, which covers tens of millions of Americans.
It’s a win for the Danish drugmaker, as CVS is elevating Wegovy at the expense of Eli Lilly’s Zepbound at a time when drugmakers compete aggressively for the nascent GLP-1 weight loss market.
The government is also currently negotiating lower prices for Novo Nordisk’s Wegovy and Ozempic in Medicare under the Inflation Reduction Act. The new rates, which take effect in 2027, are expected to eventually deflate prices for other GLP-1s.
