Cigna publicizes new deal for copay caps on Eli Lilly and Novo Nordisk weight reduction medication

Only part of well being insurer Cigna‘s purchasers these days quilt the preferred GLP-1 weight reduction medication Wegovy and Zepbound on account of their top prices. But the corporate’s pharmacy advantages unit Evernorth has reached a take care of drug makers Ely Lilly and Novo Nordisk which it stated will convey costs down for employers and their employees.

“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 30 days stated Harold Carter, Evernorth senior vp of pharmacy family members.

Many of Evernorth’s purchasers these days be offering the medication to employees with co-pays as little as $25 per 30 days. For those that had been hesitant to hide the drugs on account of price, capping worker out-of-pocket prices at $200 would quantity to lower than part the cost customers pay in money with out insurance coverage in the event that they purchased the drug via Ely Lilly or Novo Nordisk’s direct-to-consumer web sites.   

The new deal may also come with a simplified pre-authorization procedure for the medication, and sufferers will be capable of get admission to the medication for a similar value throughout retail pharmacies, or via Evernorth house supply carrier, the corporate stated.

Those new products and services and reductions can also be equipped for Evernorth purchasers already providing the load loss medication.

“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, ” stated Carter, including that Evernorth was once ready to get well pricing whilst keeping up protection for each medication.

Last month, CVS Caremark introduced that it had struck a deal to make Novo’s Wegovy its number one weight reduction drug beginning in the second one part of the yr, which might imply protection for Lilly’s Zepbound would now not be most well-liked.

Novo Nordisk would now not remark at the new pharmacy advantages preparations. But a spokesperson for Eli Lilly informed 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.”

These new preparations by means of Evernorth and CVS Caremark may convey the ones internet costs even decrease for employers, simply as the federal government is negotiating Medicare reductions for Novo Nordisk’s Ozempic and Wegovy underneath the Inflation Reduction Act.

Those Medicare negotiated charges will take impact in 2027 — successfully making Novo Nordisk’s merchandise the most well liked medication in this system. That may see costs come down even additional, stated Ben Ippolito, senior fellow in well being economics on the American Enterprise Institute.

“Once the drug is negotiated, it must be featured on formulary in Medicare. And so that means that if you’re Eli Lilly, you have to try and compete in the Medicare market with a product that’s going to be on formulary and have an artificially lower price. And so it’s going to filter through to what Eli Lilly does,” Ippolito stated.

Evernorth’s new weight reduction pricing program will start on July 1, as employers start to make selections about protection for subsequent yr’s plans.

— CNBC’s Angelica Peebles contributed to this document.