Cigna’s Evernorth Strikes Deal to Lower Cost of Wegovy and Zepbound for Employer

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. But the company’s pharmacy benefits unit Evernorth has reached a deal with drug makers Eli Lilly and Novo Nordisk which it said will bring prices down for employers and their workers.

The New Deal

“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 said Harold Carter, Evernorth senior vice president of pharmacy relations. Many of Evernorth’s clients currently offer the drugs to workers with co-pays as low as $25 per month. For those who have been hesitant to cover the medications because of cost, capping employee out-of-pocket costs at $200 would amount to less than half the price consumers pay in cash without insurance if they bought the drug through Eli Lilly or Novo Nordisk’s direct-to-consumer websites.

Simplified Pre-Authorization Process

The new deal will also include a simplified pre-authorization process for the drugs, and patients will be able to access the drugs for the same price across retail pharmacies, or through Evernorth home delivery service, the company said. Those new services and discounts will also be provided for Evernorth clients already offering the weight loss drugs.

Cost Reduction

“Clients that cover weight loss today, we’re expecting that they can see, you know, up to almost 20% a reduction [in] their costs … with this updated arrangement that we’ve been able to get with Lily and Novo, ” said Carter, adding that Evernorth was able to get better pricing while maintaining coverage for both drugs.

Industry Impact

Last month, CVS Caremark announced that it had struck a deal to make Novo’s Wegovy its primary weight loss drug starting in the second half of the year, which would mean coverage for Lilly’s Zepbound would no longer be preferred. Novo Nordisk would not comment on the new pharmacy benefits arrangements. But a spokesperson for Eli Lilly told CNBC, “Lilly will continue to work with those in health care, government and the industry to find creative solutions that help people with obesity access Zepbound.”

Net Prices Coming Down

While Cigna would not discuss the actual discounts reached under the new Evernorth arrangement, analysts say large employers and other insurers have gotten between 30% to 50% below the drugs’ list price. While Novo’s Wegovy lists for $1,350 per month, in March the average net price for the drug was $616 according to an analysis by the Institute for Clinical and Economic Review. For Lilly’s Zepbound, the list price is roughly $1,100 per month, while the net price is $725.

Future Implications

These new arrangements by Evernorth and CVS Caremark could bring those net prices even lower for employers, just as the government is negotiating Medicare discounts for Novo Nordisk’s Ozempic and Wegovy under the Inflation Reduction Act. Those Medicare negotiated rates will take effect in 2027 — effectively making Novo Nordisk’s products the preferred drugs in the program. That could see prices come down even further, said Ben Ippolito, senior fellow in health economics at the American Enterprise Institute.

Conclusion

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. This new deal is expected to make weight loss drugs more accessible to those who need them, while also reducing costs for employers and employees.

FAQs

Q: What is the new deal between Evernorth and Eli Lilly and Novo Nordisk?
A: The new deal will bring prices down for employers and their workers for the popular GLP-1 weight loss drugs Wegovy and Zepbound.
Q: How much will employees have to pay for the weight loss drugs?
A: Employees will have their out-of-pocket costs capped at $200 per month.
Q: Will the new deal affect the prices of the weight loss drugs for those who already have coverage?
A: Yes, the new deal is expected to reduce costs for employers and employees who already have coverage for the weight loss drugs.
Q: When will the new pricing program begin?
A: The new pricing program will begin in the second half of the year.
Q: How will the new deal affect the industry?
A: The new deal could bring net prices even lower for employers and may lead to further price reductions in the future.