Evernorth Benefit Option Will Cap Wegovy, Zepbound Monthly Cost at $200
The new program aims to reduce costs for patients, with savings estimated at as much as $3600 per year.
Evernorth, a division of The Cigna Group, announced a pharmacy benefit offer for semaglutide (Wegovy) and tirzepatide (Zepbound) to reduce costs for patients.1 The monthly copay will be limited to no more than $200, which can also count towards the patient’s annual deductible.
The new program aims to reduce costs for patients, ensuring a monthly cost that will not exceed $200. | Image Credit: Edugrafo - stock.adobe.com
“We are reimagining pharmacy benefits to reduce costs and better serve patients,” Adam Kautzner, PharmD, president of Evernorth Care Management and Express Scripts, said in a news release. “This is what Express Scripts does better than anyone: save Americans money on their prescriptions while helping them achieve their health goals.”
The company estimates that savings could be as much as $3600 per year when buying the weight loss medications from manufacturers or through consumer programs. Express Scripts will also conduct safety checks as part of this service to ensure quality and safety and reduce negative or adverse drug interactions.1
Through the program, patients can also select local retail pharmacies or home delivery through Evernorth’s EnGuide Pharmacy. As for health plan sponsors, the program will reduce the net cost per prescription and increase access for patients.1
“As advocates for the millions of people we serve, we drive lower medication costs through negotiations with the pharmaceutical manufacturers, and we’re making it easier than ever for health plan sponsors to cover GLP-1s for weight loss,” Harold Carter, PharmD, senior vice president of trade relations at Express Scripts, said in the news release.1 “This is how we deliver on our promise to put patients first—by making innovative medicines more accessible, at a lower cost, while providing patients and physicians choices in this fast-evolving market.”
Recently, CVS Caremark announced that Novo Nordisk’s Wegovy is their preferred glucagon-like peptide-1 medication for weight loss, pushing tirzepatide out of the formulary, which will go into effect on July 1, 2025. Since CVS Caremark possesses the largest share of the commercial benefits market, it is estimated that Wegovy will keep control of the weight loss market. This decision comes months after Novo Nordisk announced a partnership with telehealth services to provide semaglutide for weight loss.2
Novo Nordisk and Eli Lilly have both announced direct-to-patient options, which allow patients to pay cash for Wegovy and Zepbound, respectively. For NovoCare Pharmacy, all dosages for Wegovy are at a reduced cost of $499 per month. The offer is available for patients who are uninsured or for patients with commercial insurance who do not have coverage for obesity medication. As part of the program, semaglutide prescriptions will be directly delivered to the patient’s home, fulfilled by CenterWell Pharmacy. It offers patient benefit verification, refill reminders, and access to live support.3,4
As for Eli Lilly, medication is offered through LillyDirect Self Pay Pharmacy Solutions, with the 2.5 mg vial costing $349 and the 5 mg, 7.5 mg, and 10 mg vials costing $499.4
READ MORE: Obesity Management Resource Center
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