Only about half of health insurer Cigna’s clients currently cover the widely used GLP-1 weight loss drugs Wegovy and Zepbound due to their high costs. However, Cigna’s pharmacy benefits division, Evernorth, has reached agreements with drug manufacturers Eli Lilly and Novo Nordisk to lower prices, making these medications more accessible for employers and their employees. Harold Carter, Evernorth’s senior vice president of pharmacy relations, explained that the new solution targets clients not yet covering these drugs. It offers a reduced price for plan sponsors and caps members’ out-of-pocket costs at $200 per month.
For those employers already offering coverage, co-pays can be as low as $25 per month. The new cost cap of $200 represents less than half of what consumers pay if purchasing the drugs directly through the manufacturers’ websites without insurance. The agreement also simplifies the pre-authorization process, allowing patients to obtain the drugs at consistent prices whether through retail pharmacies or Evernorth’s home delivery service.
This arrangement is expected to benefit both current and prospective Evernorth clients, with clients already covering the drugs potentially seeing up to a 20% reduction in costs under the updated terms. Carter emphasized that Evernorth was able to negotiate better pricing while maintaining coverage for both Wegovy and Zepbound.
Recently, CVS Caremark announced it would make Novo Nordisk’s Wegovy its preferred weight loss medication starting in the latter half of the year, signaling a shift away from Eli Lilly’s Zepbound in its formulary. While Novo Nordisk did not comment on the new pharmacy benefits deals, Eli Lilly reaffirmed its commitment to collaborating with healthcare providers, governments, and industry partners to improve access to Zepbound.
Though the exact discounts achieved by Evernorth were not disclosed, industry analysts estimate that large employers and insurers are currently securing prices 30% to 50% below the drugs’ list prices. Novo Nordisk’s Wegovy is listed at $1,350 per month, but the average net price was approximately $616 as of March, according to an analysis by the Institute for Clinical and Economic Review. Eli Lilly’s Zepbound has a list price of about $1,100 per month, with a net price near $725.
The new pricing deals negotiated by Evernorth and CVS Caremark could push these net prices even lower for employers, particularly as the federal government is negotiating Medicare discounts for Novo Nordisk’s Ozempic and Wegovy through the Inflation Reduction Act. These Medicare-negotiated rates, which take effect in 2027, will likely make Novo Nordisk’s drugs the preferred options within the Medicare program, potentially driving prices down further.
Ben Ippolito, a senior fellow in health economics, noted that once a drug is included on Medicare’s formulary at a negotiated price, companies like Eli Lilly will need to compete with these artificially lower prices in the broader market, which could influence their pricing strategies.
Evernorth’s updated weight loss drug pricing program is scheduled to launch in the second half of the year, aligning with employers’ planning and decision-making for coverage options in upcoming benefit years. This move aims to improve affordability and access to these effective GLP-1 treatments, responding to growing demand for weight loss medications amid widespread health concerns.
READ MORE: