Insurance Coverage For Weight Loss Drugs - Cigna Unveils Efforts To Limit Health Plans/Employers Spending

Thursday, Evernorth Health Services, a subsidiary of Cigna Group CI introduced a financial guarantee within its EncircleRx program.

The move aims to provide clients with predictability when covering GLP-1s, ultimately empowering companies and health plans to exercise better control over their expenditures.

This expansion allows for a cost cap or savings guarantee, fostering accessibility for deserving patients.

“Our industry-first financial guarantee offers employers and health plans greater predictability and control of their GLP-1 spend,” said Adam Kautzner, president of Express Scripts and Evernorth Care Management.

Cardiodiabesity, a complex interplay of obesity, diabetes, and cardiovascular disease, accounts for a staggering $719 billion in annual healthcare costs. 

Evernorth’s EncircleRx, driven by data and supply chain expertise, presents a data-driven solution for health plans to navigate these conditions effectively. 

Apart from the financial guarantees protecting against the rising cost curve of GLP-1s, EncircleRx serves as a gateway for employers and health plans to leverage Evernorth’s insights and clinical expertise. 

CNBC noted that Cigna’s pharmacy benefits management unit has reached agreements with Novo Nordisk A/S NVO and Eli Lilly And Co LLY to cap annual spending increases for weight loss and diabetes drugs at a maximum of 15%. 

This move comes in response to the current trend where some health plans experience annual spending increases of 40% to 50% on these drugs.

Omada Health has collaborated with the Evernorth Research Institute to investigate the connection between utilizing GLP-1 (glucagon-like peptide-1) and supporting lifestyle changes. 

The initiative centered on individuals engaged in Omada for Prevention, a virtual program offering personalized lifestyle support. 

Participants maintained a baseline weight and underwent monthly follow-up weight checks as part of the pilot program.

Cigna raised its long-term average annual adjusted EPS growth target to 10%-14%.

The insurance provider reaffirmed its fiscal year 2024 adjusted EPS guidance of at least $28.25 versus the consensus of $28.42.

Price Action: CI shares are up 0.29% at $340.77 on the last check Thursday.

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