Cigna’s Evernorth division is initiating a transformative approach with its pharmacy benefit manager, Express Scripts, by moving towards a rebate-free model, marking a significant shift in the industry’s traditional practices. This announcement reflects Cigna’s commitment to enhancing transparency, improving the patient experience, and bolstering support for community pharmacies.
Evernorth outlined its strategy, emphasizing a pass-through model that offers upfront discounts to members. This new framework signifies a major transition for the company, with plans for Cigna Healthcare to implement this model across its fully insured plans by 2027. Furthermore, this transparent approach will become the standard offering for all customers of Express Scripts starting in 2028.
Despite advancements in making generic medications more affordable, Cigna’s leadership acknowledged that branded drug prices still pose a considerable challenge for patients. The newly introduced model aims to address these financial barriers, seeking to lower the costs associated with high-priced brand-name drugs while fostering the use of generics and biosimilars.
Adam Kautzner, President of Evernorth Care Management and Express Scripts, remarked on the progression made in pharmacy benefits. He pointed out that the new model is designed to provide greater choice and affordability for Americans, stating, “We’re creating more choice for Americans by lowering the costs of expensive brand-name drugs while driving accelerated adoption of generics and biosimilars.”
Cigna estimates that the new model will yield an average savings of 30% per month for members on brand-name medications. Leveraging technology, the system will facilitate the comparison of pricing options at the pharmacy counter, ensuring that patients have access to the lowest available costs when picking up prescriptions. For instance, if a negotiated price is presented as $22, but there are options for a $25 copayment or a $20 cash price, patients will only be charged the lowest amount—$20 in this case.
Currently, tens of millions of members are benefiting from this technology, with plans to extend access to even more individuals in January. Evernorth is also providing members the opportunity to pay the negotiated price for branded medications that are not covered by their insurance.
Additionally, a cost-plus reimbursement model for pharmacies will be implemented, compensating them based on their acquisition costs for medications along with an added dispensing fee. This reimbursement strategy aims to support community pharmacies and is set to be rolled out across the pharmacy network in 2026.
David Cordani, CEO of the Cigna Group, highlighted the ongoing mission of Evernorth, stating that the organization intends to further prioritize the needs of Americans by reducing drug costs, ensuring access to trusted pharmacies, and delivering necessary clinical support for patient health.
