Evernorth Launches Co-Pay Cap for Weight Loss Drugs Amid New Federal Drug Pricing Effort

Evernorth, Cigna's health services division, secured a $200 monthly co-pay cap for the antiobesity medications semaglutide (Wegovy; Novo Nordisk) and tirzepatide (Zepbound; Eli Lilly) through direct negotiations with manufacturers.¹ The move comes as federal efforts to reduce prescription drug costs continue to gain momentum.²

Evernorth Introduces First-of-Its-Kind Benefit to Expand Weight Loss Drug Access, Affordability

Evernorth described the initiative as a first-of-its-kind pharmacy benefit that offers savings, choice, and predictability to both patients and health plan sponsors.¹ The company said patients can save up to $3600 annually on weight loss medications through this pharmacy benefit compared with purchasing them directly from manufacturers or through customer programs. The $200 co-pay cap also counts toward their annual deductible.

Additionally, receiving weight loss medications through Evernorth includes simplified and automated prior authorization processes, enabling faster patient access. For convenience, Evernorth said patients can choose from a broad network of local retail pharmacies or opt for home delivery through its EnGuide Pharmacy.

The company claimed health plans will see a significant reduction in the net cost per prescription of weight loss medications with this new benefit. It added that the benefit also ensures patients have access to the best medication for their needs without compromising affordability or clinical safety.

Evernorth caps weight loss drug monthly co-pays at $200, enhancing access and affordability for semaglutide and tirzepatide amid new drug pricing initiatives. | Image Credit: alones - stock.adobe.com

“As advocates for the millions of people we serve...we’re making it easier than ever for health plan sponsors to cover GLP-1s [glucagon-like peptide-1 drugs] for weight loss,” Harold Carter, PharmD, senior vice president of trade relations at Express Scripts, Evernorth’s pharmacy benefit manager, said in the press release. “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.”

Federal Drug Pricing Reform Seeks to Rein in Costs With Global Benchmarking

Evernorth's launch comes one day after HHS announced it is proceeding with implementing President Donald Trump's executive order, “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients.”² The order's goal is to set price targets for pharmaceutical manufacturers on products without generic or biosimilar competition.

HHS Secretary Robert F. Kennedy Jr and CMS Administrator Mehmet Oz, MD, set the target price at the lowest level found in an Organisation for Economic Co-operation and Development country with a gross domestic product per capita of at least 60% of the US level. The Trump administration claims that establishing the most favored nation pricing will reduce drug prices by 30% to 80%.

“For too long, Americans have been forced to pay exorbitant prices for the same drugs that are sold overseas for far less,” Kennedy said in a statement.³ “That ends today. We expect pharmaceutical manufacturers to fulfill their commitment to lower prices for American patients, or we will take action to ensure they do.”

As detailed in the executive order, the Trump administration will pursue a series of policies if it doesn't see significant progress from manufacturers to offer drugs to consumers at the price set by HHS.

The pharmaceutical industry pushed back against the order shortly after it was signed. For example, Stephen J. Ubl, CEO of the Pharmaceutical Research and Manufacturers of America, or PhRMA, responded by placing the blame for high drug prices in the US on pharmacy benefit managers, insurers, and hospitals.⁴

“Importing foreign prices from socialist countries would be a bad deal for American patients and workers,” Ubl said in a statement. “It would mean less treatments and cures and would jeopardize the hundreds of billions our member companies are planning to invest in America—threatening jobs, hurting our economy and making us more reliant on China for innovative medicines.”

However, there is optimism about the potential impact of this pricing model. For instance, AARP Executive Vice President and Chief Advocacy and Engagement Officer Nancy LeaMond said this order will help rein in prices; AARP fought for Medicare to have the ability to negotiate drug prices.⁵

“For too long, big drug companies have been ripping off America’s seniors—charging the highest prices in the world for lifesaving prescriptions, padding their profits at the expense of American lives, and forcing older adults to skip medications they can’t afford,” she said in a statement. “We look forward to reviewing the details and understanding how these changes will affect seniors’ pocketbooks.”

References

1. Evernorth launches new benefit option that drives lower net cost for weight loss medicines and limits patient cost to no more than $200 per month. News release. Evernorth Health Services; May 21, 2025. Accessed May 22, 2025. https://www.evernorth.com/articles/evernorth-launches-new-benefit-option-drives-lower-net-cost-weight-loss-medicines
2. Joszt L. HHS sets pricing target for Trump's Most Favored Nation drug price model. AJMC^®. May 20, 2025. Accessed May 22, 2025. https://www.ajmc.com/view/hhs-sets-pricing-target-for-trump-s-most-favored-nation-drug-price-model
3. HHS, CMS set most-favored-nation pricing targets to end global freeloading on American patients. News release. HHS; May 20, 2025. Accessed May 22, 2025. https://www.hhs.gov/press-room/cms-mfn-lower-us-drug-prices.html
4. PhRMA statement on most favored nation executive order. PhRMA. May 12, 2025. Accessed May 22, 2025. https://phrma.org/resources/phrma-statement-on-most-favored-nation-executive-order
5. AARP responds to the most favored nation executive order. AARP. May 12, 2025. Accessed May 22, 2025. https://press.aarp.org/AARP-Statement-Most-Favored-Nation-Executive-Order