Evernorth Announces New Cost and Transparency Protections for its Express Scripts Patients
Evernorth Health Services, a subsidiary of The Cigna Group (NYSE: CI), announced new initiatives to improve pharmacy benefit costs and transparency for Express Scripts patients. The company is implementing protections to ensure patients benefit directly from drug price negotiations and receive lower out-of-pocket costs at pharmacy counters.
Key measures include protecting patients from paying high list prices by providing access to Express Scripts' negotiated lower prices, particularly benefiting those in employer-sponsored plans during their deductible phase. Currently, over 80% of Express Scripts' patients pay less than $100 per year for prescriptions.
The company is also enhancing transparency through new reporting features, including personalized summaries for patients detailing annual prescription costs, negotiated savings, and total savings. Plan sponsors will receive standardized reports with cost disclosures and pharmacy claim-level reporting for improved oversight.
Evernorth Health Services, una filiale del Cigna Group (NYSE: CI), ha annunciato nuove iniziative per migliorare i costi e la trasparenza dei benefici farmaceutici per i pazienti di Express Scripts. L'azienda sta implementando misure di protezione per garantire che i pazienti possano beneficiare direttamente delle negoziazioni sui prezzi dei farmaci e ricevere costi inferiori al banco della farmacia.
Le misure chiave includono la protezione dei pazienti dal pagamento di alti prezzi di listino, fornendo accesso ai prezzi negoziati più bassi di Express Scripts, a beneficio soprattutto di coloro che si trovano in piani sponsorizzati dai datori di lavoro durante la fase di franchigia. Attualmente, oltre l'80% dei pazienti di Express Scripts paga meno di 100 dollari all'anno per le prescrizioni.
L'azienda sta inoltre migliorando la trasparenza attraverso nuove funzionalità di reporting, tra cui riepiloghi personalizzati per i pazienti che dettagliamo i costi annuali delle prescrizioni, i risparmi negoziati e il risparmio totale. I promotori del piano riceveranno report standardizzati con divulgazioni sui costi e report a livello di richiesta farmaceutica per una migliore supervisione.
Evernorth Health Services, una subsidiaria de The Cigna Group (NYSE: CI), anunció nuevas iniciativas para mejorar los costos de los beneficios farmacéuticos y la transparencia para los pacientes de Express Scripts. La empresa está implementando protecciones para asegurar que los pacientes se beneficien directamente de las negociaciones de precios de los medicamentos y reciban costos más bajos de su bolsillo en las farmacias.
Las medidas clave incluyen la protección de los pacientes contra el pago de altos precios de lista al proporcionar acceso a los precios negociados más bajos de Express Scripts, beneficiando particularmente a quienes están en planes patrocinados por empleadores durante su fase de deducible. Actualmente, más del 80% de los pacientes de Express Scripts paga menos de $100 al año por las recetas.
La empresa también está mejorando la transparencia a través de nuevas características de informes, incluidos resúmenes personalizados para los pacientes que detallan los costos anuales de las recetas, los ahorros negociados y el ahorro total. Los patrocinadores del plan recibirán informes estandarizados con divulgaciones de costos y reportes a nivel de reclamos farmacéuticos para una mejor supervisión.
에버노스 헬스 서비스(Evernorth Health Services)는 Cigna 그룹(The Cigna Group) (NYSE: CI)의 자회사로서, Express Scripts 환자를 위한 약국 혜택 비용 및 투명성을 개선하기 위한 새로운 이니셔티브를 발표했습니다. 이 회사는 환자들이 약물 가격 협상의 직접적인 혜택을 받을 수 있도록 보호 조치를 시행하고, 약국에서 저렴한 본인 부담 비용을 받을 수 있도록 하고 있습니다.
주요 조치로는 환자들이 높은 정가를 지불하지 않도록 보호하고, 특히 공공 고용자 후원 계획에서 공제 단계에 있는 경우 Express Scripts의 협상된 저렴한 가격에 접근할 수 있도록 하는 것입니다. 현재 Express Scripts 환자의 80% 이상이 연간 처방약 비용으로 100달러 미만을 지불하고 있습니다.
회사는 연간 처방약 비용, 협상된 절약 금액 및 총 절약금을 상세히 설명하는 개인화된 요약을 포함하여 새로운 보고 기능을 통해 투명성을 향상하고 있습니다. 계획 후원자는 개선된 감독을 위한 비용 공개 및 약국 청구 수준 보고가 포함된 표준화된 보고서를 받게 됩니다.
Evernorth Health Services, une filiale de The Cigna Group (NYSE: CI), a annoncé de nouvelles initiatives pour améliorer les coûts et la transparence des prestations pharmaceutiques pour les patients d'Express Scripts. L'entreprise met en place des protections pour garantir que les patients bénéficient directement des négociations sur les prix des médicaments et reçoivent des coûts moins élevés de leur poche aux comptoirs des pharmacies.
Les principales mesures incluent la protection des patients contre le paiement de prix de liste élevés en leur offrant un accès aux prix plus bas négociés par Express Scripts, ce qui profite en particulier à ceux qui sont dans des plans sponsorisés par des employeurs pendant leur phase de franchise. Actuellement, plus de 80 % des patients d'Express Scripts paient moins de 100 $ par an pour leurs prescriptions.
L'entreprise améliore également la transparence grâce à de nouvelles fonctionnalités de reporting, y compris des résumés personnalisés pour les patients détaillant les coûts annuels des prescriptions, les économies négociées et les économies totales. Les sponsors de plans recevront des rapports standardisés avec des divulgations de coûts et des rapports au niveau des demandes de pharmacie pour améliorer la supervision.
Evernorth Health Services, eine Tochtergesellschaft der Cigna Group (NYSE: CI), hat neue Initiativen zur Verbesserung der Kosten und der Transparenz von Apothekenleistungen für Patienten von Express Scripts angekündigt. Das Unternehmen führt Schutzmaßnahmen ein, um sicherzustellen, dass die Patienten direkt von den Preisverhandlungen für Medikamente profitieren und niedrigere Kosten aus eigener Tasche an den Apothekenkassen erhalten.
Zu den wichtigsten Maßnahmen gehört der Schutz der Patienten davor, hohe Listenpreise zu zahlen, indem ihnen der Zugang zu den von Express Scripts ausgehandelten niedrigeren Preisen gewährt wird, was insbesondere denjenigen zugutekommt, die sich in der Selbstbehaltphase von arbeitgeberfinanzierten Plänen befinden. Derzeit zahlen über 80 % der Patienten von Express Scripts weniger als 100 US-Dollar pro Jahr für Rezepte.
Das Unternehmen verbessert auch die Transparenz durch neue Berichtsfunktionen, darunter personalisierte Zusammenfassungen für Patienten, die die jährlichen Kosten von Rezepten, die ausgehandelten Einsparungen und die Gesamtersparnisse detailliert darstellen. Die Plananbieter erhalten standardisierte Berichte mit Kostentransparenz und Apothekenabrechnungsberichten zur Verbesserung der Aufsicht.
- Implementation of lower negotiated drug prices for patients instead of list prices
- Enhanced cost transparency through detailed reporting for patients and plan sponsors
- Improved financial predictability for patients in employer-sponsored plans
- 80% of Express Scripts patients currently pay less than $100 annually for prescriptions
- None.
Insights
This strategic move by Evernorth comes amid intensifying scrutiny of PBM practices and represents a proactive response to mounting regulatory pressure and public criticism of pharmacy benefit managers. The announcement introduces three pivotal changes that could reshape the PBM landscape:
First, the shift to negotiated rates over list prices addresses a long-standing criticism of the PBM model. This change is particularly significant for the approximately 20% of Express Scripts' patients who currently pay more than
Second, the enhanced transparency measures, including detailed cost reporting for both patients and plan sponsors, align with recent federal and state-level legislative efforts to increase PBM accountability. This proactive stance could position Cigna favorably ahead of potential regulatory requirements.
Third, the standardization of claim-level reporting for plan sponsors represents a significant operational shift that could set new industry standards for transparency. This could pressure competitors to follow suit, potentially triggering a broader industry transformation.
The timing of these changes is strategic, as it precedes potential federal legislation on PBM reform. By voluntarily implementing these changes, Evernorth demonstrates market leadership while potentially influencing the shape of future regulations. However, these reforms may impact profit margins in the short term as the business model adapts to increased transparency and potentially lower spread pricing revenues.
This strategic initiative carries significant implications for Cigna's market position and financial performance. The move addresses two critical market dynamics: increasing regulatory scrutiny and growing competition in the PBM space.
The timing is particularly noteworthy as it coincides with heightened focus on healthcare costs and PBM practices. By proactively implementing these changes, Evernorth positions itself ahead of potential regulatory mandates, potentially creating a competitive advantage. This could help secure and expand its 100 million+ customer base, particularly among large employers increasingly demanding transparency.
However, the financial implications are nuanced. While the enhanced transparency and cost-saving measures might pressure near-term margins, they could drive longer-term value through:
- Increased market share from improved customer satisfaction and competitive differentiation
- Reduced regulatory risk and associated compliance costs
- Strengthened positioning for government contracts and large employer relationships
The standardized reporting initiative suggests a shift toward a more sustainable revenue model, potentially reducing reliance on traditional spread pricing and rebate retention. This could lead to more predictable revenue streams and potentially higher valuation multiples as the business model becomes more transparent and less controversial.
- Actions aim to lower patient out-of-pocket costs
- Expands transparency for both patients and those who provide their benefits
"We know that health care and prescription drugs need to be more affordable, and that coverage needs to be more transparent and less complex," said Eric Palmer, President and CEO of Evernorth Health Services. "While we advocate for the lowest costs for the more than 100 million Americans we serve, we know there are times where the system falls short. We hear the concerns of patients, plan sponsors and the public, and are making these commitments as one step to do more to help patients get their medications at the lowest cost and improve transparency to enable more informed choices."
Today, Evernorth is implementing protections to help lower costs for patients at the pharmacy counter.
Helping All Patients Benefit Directly from Express Scripts' Drug Price Negotiations
While today more than
Evernorth is implementing protections to lower out-of-pocket costs for more patients. These actions are designed to help ensure patients receive the benefit of the savings Express Scripts generates through its negotiations. Going forward, Evernorth's standard offerings will provide the following protections:
1. Patients will be protected from paying the high list price of their medication, and will instead get access to the lower price negotiated by Express Scripts.
2. Patients in employer-sponsored plans will have improved financial predictability, receiving the benefit of the savings on medication costs that Express Scripts negotiates, if they don't already. This will be particularly meaningful to patients during their deductible phase when the cost of medications can be at their highest.
Providing Patients and Plan Sponsors with New Pharmacy Benefits Summaries and Disclosures
Express Scripts is also improving transparency through new reports which will:
3. Provide patients a personalized summary that details each patient's annual total prescription drug costs, including medication prices, negotiated savings inclusive of discounts and rebates, plan paid amounts, and total savings.
4. Provide plan sponsors with an annual standardized report disclosing costs and pharmacy claim-level reporting, which will create additional transparency beyond the routine reporting and insights Express Scripts already delivers.
"It is our goal to always exceed patient expectations for better health and to ensure there are no surprises at the pharmacy counter," said Adam Kautzner, Pharm.D., President of Evernorth Care Management and Express Scripts. "We want to do our part to lead change so patients can afford their medications and understand how their pharmacy benefits are working for them."
About Evernorth Health Services
Evernorth Health Services creates pharmacy, care and benefits solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Evernorth capabilities are powered by our businesses, including Express Scripts, Express Scripts® Pharmacy, Accredo, EviCore and MDLIVE, along with holistic Evernorth platforms and solutions that move people and organizations forward. All Evernorth solutions are serviced and provided by or through operating affiliates of Evernorth Health, a wholly owned subsidiary of The Cigna Group (NYSE: CI), or third-party partners. Learn more at evernorth.com.
Media Contact
Justine Sessions
860-810-6523
justine.sessions@evernorth.com
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SOURCE Evernorth
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