Prescription drugs to be more affordable, accessible through Cigna’s PBM Express Scripts

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Health insurer Cigna’s pharmacy benefit manager (PBM) is changing its business model to become more affordable and accessible, according to the company.

Express Scripts, the pharmacy benefits manager of Evernorth, a subsidiary of The Cigna Group, announced plans that will “accelerate pharmacy care and lower the cost of prescription drugs for more than 100 million Americans,” starting this summer.

“Our mission is simple: lower the cost of prescription drugs for the one in three Americans we serve,” Express Scripts President Adam Kautzner, PharmD, said in a statement.

The company’s plans “demonstrate our ongoing commitment to that mission, and helps clients and consumers see the value of their pharmacy benefits at work more quickly in their daily lives,” Kautzner said. “Because at the end of every prescription is a consumer and client putting their trust in us – that’s a responsibility that drives us each day.”

The move comes as the Senate, the House of Representatives, the president’s administration, and the Federal Trade Commission all have called for regulation on PBMs, and for lower drug prices, including insulin, for patients. PBMs this year launched their own information campaign explaining their role in saving money for patients.

The plans

The new Copay Assurance plan (CAP) will limit consumer out-of-pocket costs for prescription drugs to $5 for generics and specialty generics, $25 for preferred brand drugs, and $45 for preferred specialty brand drugs every time patients fill a prescription. The program will guarantee the new prices immediately with customers not required to meet deductibles.

Members can save more than 25% at the pharmacy counter, according to Express Scripts.

Kautzner touted the moves as another step to improve health of consumers by making prescription drugs available through lower costs. Consumers have saved more than $45 million in two years through the company’s $25 price cap on out-of-pocket costs for insulin.

“Our new Copay Assurance plan builds on this success and aggressively expands our efforts across medications to treat all diseases – providing millions more people with predictability and peace of mind at the pharmacy counter,” Kautzner said.

Transparency for clients

Express Scripts announced the new ClearCareRx plan for employers, health plans, and government clients. They will “pay exactly what Express Scripts pays pharmacies for a prescription” and receive 100% of drug rebates that Express Scripts negotiates with pharmaceuticals.

Clients will pay a fee to cover administration and “is 100% auditable.”

“Expanding on our proven track record of driving transparency, ClearCareRx drives greater simplicity, with strategies to further reduce costs and improve health and pharmacy care. If we don’t deliver on a client’s goals, they pay less, guaranteed,” Kautzner said.

Additional disclosures

Express Scripts also announced new measures to disclose more to consumers and clients:

• Consumers will get new digital pharmacy benefits statements with drug prices and other information starting in 2024.
• Clients can select PBM pricing options based on their needs.
• A new website will have information about Express Scripts.