Only half of health insurer Cigna ‘s clients currently cover the popular GLP-1 weight loss drugs Wegovy and Zepbound because of their high costs.
Many of Evernorth’s clients currently offer the drugs to workers with co-pays as low as $25 per month.
Those new services and discounts will also be provided for Evernorth clients already offering the weight loss drugs.
Those Medicare negotiated rates will take effect in 2027 — effectively making Novo Nordisk’s products the preferred drugs in the program.
Evernorth’s new weight loss pricing program will begin in the second half of the year, as employers begin to make decisions about coverage for next year’s plans.
Due to their high cost, the popular GLP-1 weight loss medications Wegovy and Zepbound are currently only covered by half of Cigna’s clients who have health insurance. However, Evernorth, the company’s pharmacy benefits division, has a deal with pharmaceutical companies Novo Nordisk and Ely Lilly that will lower costs for employers and their employees.
According to Harold Carter, senior vice president of pharmacy relations at Evernorth, “this solution is really focused towards clients that aren’t covering it today, and what it allows us to do is one, to bring it on at a reduced price for the plan sponsor, but also capping out the members’ cost at $200 per month.”.
At the moment, a number of Evernorth’s clients provide the medications to employees with co-pays as low as $25 per month. For those who have been reluctant to pay for the drugs due to the expense, limiting employee out-of-pocket expenses to $200 would be less than half of what customers would pay in cash without insurance if they purchased the medication from the direct-to-consumer websites of Novo Nordisk or Ely Lilly.
According to the company, the new agreement will also simplify the pre-authorization process for the medications, and patients will be able to obtain them at the same cost from retail pharmacies or via Evernorth’s home delivery service.
The new services and discounts will also be extended to Evernorth customers who currently use the weight-loss medications.
Carter said, “With this updated arrangement that we’ve been able to get with Lily and Novo, we’re expecting that clients that cover weight loss today can see, you know, up to almost 20 percent a reduction [in] their costs.” Evernorth was able to secure better pricing while keeping coverage for both medications.
When CVS Caremark revealed last month that it had reached an agreement to make Novo’s Wegovy its main weight-loss medication beginning in the second half of the year, coverage for Lilly’s Zepbound would no longer be preferred.
Regarding the new pharmacy benefits plans, Novo Nordisk would not comment. However, an Eli Lilly representative told CNBC, “Lilly will keep collaborating with the government, industry, and health care sectors to develop innovative ways to make Zepbound accessible to obese individuals. “.”.
Analysts claim that big employers and other insurers have received discounts ranging from 30 to 50 percent off the list price of the medications, though Cigna would not comment on the precise savings obtained under the new Evernorth arrangement.
The average net price of Novo’s Wegovy was $616 in March, despite the drug’s $1,350 monthly listing price, according to an analysis by the Institute for Clinical and Economic Review. The list price of Lilly’s Zepbound is approximately $1,100 per month, but the net price is $725.
As the government negotiates Medicare discounts for Novo Nordisk’s Ozempic and Wegovy under the Inflation Reduction Act, these new agreements between Evernorth and CVS Caremark may further reduce those net prices for employers.
When those Medicare negotiated rates go into effect in 2027, Novo Nordisk’s products will essentially become the program’s preferred medications. According to Ben Ippolito, senior fellow in health economics at the American Enterprise Institute, that could result in even more price reductions.
Following negotiation, the medication needs to be listed on Medicare’s formulary. Eli Lilly would therefore need to attempt to compete in the Medicare market with a product that will be on the formulary and have a phony lower price. Therefore, it will influence Eli Lilly’s actions,” Ippolito stated.
During the second half of the year, Evernorth will launch its new weight loss pricing program as employers start deciding what will be covered in their plans for the following year.
— Angelica Peebles of CNBC reported on this story.
Revision: The second half of the year will see the start of the pricing program. The timeline in an earlier iteration of this story was inaccurate.
