Cigna's Evernorth division is rolling out a rebate-free model for its pharmacy benefit manager, Express Scripts—meaning one of the industry's "Big Three" is moving away from the oft-criticized approach.
Cigna announced Monday morning that what it's calling a "new era" for its PBM unit is built on three core elements: transparency, a better patient experience and greater support for community pharmacies. The company said that Evernorth will shift to a pass-through model, where discounts are available upfront to members.
Cigna's insurance arm, Cigna Healthcare, will adopt this model for its fully insured plans in 2027, and the more transparent model will be the standard offering for all of Express Scripts' customers beginning in 2028.
In the announcement, Cigna's top brass notes that while significant progress has been made around affordability for generics, which make up the vast majority of prescriptions and biosimilars, branded drug products often remain out of reach financially for patients. This new model aims to change that paradigm.
"Pharmacy benefit managers have successfully driven down costs for Americans with generics and now with biosimilars," said Adam Kautzner, president of Evernorth Care Management and Express Scripts, in the release. "In this new era of pharmacy benefits, we're creating more choice for Americans by lowering the costs of expensive brand-name drugs while driving accelerated adoption of generics and biosimilars."
"Our innovative model is a win-win for Americans and their employers—lower costs for Americans, real-time transparency for employers and renewed trust in pharmacy benefits for all," Kautzner said.
Per the announcements, Evernorth estimates that the new model will save members an average of 30% each month on brand-name medications. It will lean on technology to compare pricing options for the patient and ensure they see the lowest cost when they pick up a prescription.
For example, if a patient's medication has a $22 negotiated price through Express Scripts, a $25 copayment, a $20 cash price option or a $50 direct-to-consumer cost through manufacturer, they'll be charged $20 at the pharmacy counter, Evernorth said.
The company said that tens of millions of members currently benefit from this tech and it will expand to even more in January. Evernorth will also offer members the option to pay its negotiated price for branded drugs even if the product isn't covered under their insurance.
In addition, Evernorth said that it will adopt a cost-plus reimbursement model for pharmacies, paying them based on their cost for medications with a dispensing fee added in. The PBM also said it plans to offer "additional reimbursement" for clinical services provided by these pharmacies.
The new reimbursement model will be rolled out across its pharmacy network beginning in 2026, Evernorth said.
"We are building on our long track record of pharmacy benefits innovation to put Americans first—lowering their drug costs, protecting access to their trusted pharmacies, and providing the clinical support and safety checks they need to stay healthy," said David Cordani, CEO of the Cigna Group, in the announcement.