#United States #Cigna Group #Bloomfield #Evernorth #Pharmacy Benefit

A New Era of Pharmacy Benefits

In an ambitious move to dial down U.S. medication costs, Evernorth, the healthcare service branch of The Cigna Group, recently unveiled a revolutionary rebate-free pharmacy benefit model. This initiative is not only designed to lower costs associated with purchasing medications but also aims to enhance transparency and provide better support for local pharmacies across the nation.

David M. Cordani, Chairman and CEO of The Cigna Group, expressed gratitude for the initiatives led by President Trump and his administration to curb the high costs of brand-name medicines. He emphasized that despite the advancements made by pharmacy benefit managers (PBMs) in reducing prices for generics—accounting for 90% of all prescriptions—brand-name medications still pose a significant financial burden for many Americans.

The new pharmacy benefit model from Evernorth is anchored in the following three core components:

1. Transparent, Rebate-Free Services

Evernorth plans to eradicate the convoluted rebate process once and for all by implementing a more straightforward system where consumers receive upfront discounts on their prescriptions. This shift will empower Americans to benefit directly from the negotiated prices, noticeably reducing their costs, especially for brand-name drugs. The aim is to simplify procurement processes for businesses and health plans, ensuring greater visibility and easier predictions regarding drug expenditures.

2. Enhanced Affordability

The groundbreaking model promises significant financial relief for Americans, particularly those using high-deductible health plans. With an average anticipated reduction of 30% on monthly costs for brand-name medications, Evernorth is poised to make prescription drugs more affordable and accessible. Users will be charged the lowest available price for their medication, whether that be via Evernorth’s negotiated rates, cash pricing, or copay structures. This pricing model leverages advanced technology to automatically compare different pricing arrangements, guaranteeing the best deal for patients at the pharmacy.

For instance, if a medication is priced at:

• - Evernorth negotiated cost: $22 (70% off the list price)
• - Cash discount: $20
• - Direct-to-consumer price: $50
• - Copay: $25

The consumer would only pay $20, as this is the most cost-effective option. Evernorth aims to introduce this efficient pricing strategy next year, coinciding with additional programs that ensure their clients continually receive the most competitive offers available.

3. Promoting Community Pharmacies

Recognizing that local pharmacies serve as vital access points for healthcare, Evernorth will also modify its reimbursement framework to provide these establishments with fair compensation. The new model compensates pharmacies based on their drug costs plus fees for clinical services. By enhancing the quality of care and rewarding exceptional patient service, Evernorth expects to enable local pharmacies to deliver better health outcomes for their communities.

This new framework will be rolled out to all in-network pharmacies starting in 2026, marking a significant leap in improving patient care and service standards across the board.

Evernorth's introduction of this innovative pharmacy benefit model not only aims to reduce Americans' financial burdens but also reinforces their commitment to ensuring accessible healthcare. With a legacy of affordability and innovative health solutions, Evernorth continues to rise as a leader in transforming pharmacy benefits and healthcare services, striving to create a healthier and more transparent health system for all Americans.

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About Evernorth Health Services

Evernorth Health Services is dedicated to enhancing health and wellness through comprehensive pharmacy and care solutions. Leveraging capabilities from multiple sectors, including Express Scripts and MDLIVE, Evernorth aims to make illness prevention and treatment more readily accessible to millions of individuals. To explore further, visit evernorth.com.