Evernorth Strikes Deals with Novo Nordisk and Eli Lilly to Cap GLP-1 Drug Costs

Cigna's health services arm, Evernorth, has announced groundbreaking agreements with pharmaceutical giants Novo Nordisk and Eli Lilly to cap out-of-pocket costs for popular GLP-1 weight loss medications. This move marks a significant step towards improving accessibility and affordability of these increasingly sought-after drugs.

New Benefit Program Caps Patient Costs and Offers Discounts

Evernorth's latest initiative introduces a benefit option that caps monthly out-of-pocket costs for Novo Nordisk's Wegovy and Eli Lilly's Zepbound at $200 for participating patients. This program could potentially save consumers up to $3,600 annually compared to purchasing the drugs directly from manufacturers or through other patient assistance programs.

In addition to patient savings, the agreements provide deeper discounts of up to 20% per prescription for employers and health plans contracting with Evernorth for prescription drug plans. Adam Kautzner, president of Evernorth Care Management and Express Scripts, stated, "We are reimagining pharmacy benefits to reduce costs and better serve patients. This is what Express Scripts does better than anyone: save Americans money on their prescriptions while helping them achieve their health goals."

Expanding Access and Streamlining Processes

The new program goes beyond cost savings, offering several additional benefits to improve patient access and experience:

1. A simplified prior authorization process
2. Patient choice of pharmacy, including local retail pharmacies or Evernorth's home delivery option
3. Expedited prior authorization approvals when needed
4. Option for patients to pick up medications from any Express Scripts in-network pharmacy or through its EnGuide home delivery service

These features are designed to make it easier for patients to obtain and maintain their GLP-1 prescriptions while also providing flexibility in how they receive their medications.

Market Impact and Industry Context

The introduction of this program comes at a crucial time in the rapidly expanding GLP-1 market. Despite high demand and increasing acceptance of GLP-1s for various conditions, including obesity, fewer than one in five employer-sponsored plans covered these drugs for weight loss in 2024, largely due to cost concerns.

With list prices for Wegovy and Zepbound at approximately $1,350 and $1,060 per month respectively before discounts, the financial burden has been a significant barrier to access. Evernorth's initiative could potentially nudge more of its clients to cover GLP-1s, as currently only half of its employer clients cover these drugs for weight management.

This move by Evernorth follows a recent deal between rival pharmacy benefit manager CVS Caremark and Novo Nordisk, which gave Wegovy preferred access on Caremark's standard formulary. As competition in the GLP-1 weight loss market intensifies, these agreements could play a crucial role in shaping market dynamics and patient access to these medications.