Cigna announces new deal for copay caps on Eli Lilly and Novo Nordisk weight loss drugs

Only half of health insurer Cigna‘s clients currently cover the popular GLP-1 weight loss drugs Wegovy and Zepbound because of their high costs. But the company’s pharmacy benefits unit Evernorth has reached a deal with drug makers Ely Lilly and Novo Nordisk which it said will bring prices down for employers and their workers.

“This solution is really focused towards clients that aren’t covering it today, and what it allows us to do is one, to bring it on at a reduced price for the plan sponsor, but also capping out the members’ cost at $200,” per month said Harold Carter, Evernorth senior vice president of pharmacy relations.

Many of Evernorth’s clients currently offer the drugs to workers with co-pays as low as $25 per month. For those who have been hesitant to cover the medications because of cost, capping employee out-of-pocket costs at $200 would amount to less than half the price consumers pay in cash without insurance if they bought the drug through Ely Lilly or Novo Nordisk’s direct-to-consumer websites.   

The new deal will also include a simplified pre-authorization process for the drugs, and patients will be able to access the drugs for the same price across retail pharmacies, or through Evernorth home delivery service, the company said.

Those new services and discounts will also be provided for Evernorth clients already offering the weight loss drugs.

“Clients that cover weight loss today, we’re expecting that they can see, you know, up to almost 20% a reduction [in] their costs … with this updated arrangement that we’ve been able to get with Lily and Novo, ” said Carter, adding that Evernorth was able to get better pricing while maintaining coverage for both drugs.

Last month, CVS Caremark announced that it had struck a deal to make Novo’s Wegovy its primary weight loss drug starting in the second half of the year, which would mean coverage for Lilly’s Zepbound would no longer be preferred.

Novo Nordisk would not comment on the new pharmacy benefits arrangements. But a spokesperson for Eli Lilly told CNBC, “Lilly will continue to work with those in health care, government and the industry to find creative solutions that help people with obesity access Zepbound.”

While Cigna would not discuss the actual discounts reached under the new Evernorth arrangement, analysts say large employers and other insurers have gotten between 30% to 50% below the drugs’ list price.

While Novo’s Wegovy lists for $1,350 per month, in March the average net price for the drug was $616 according to an analysis by the Institute for Clinical and Economic Review. For Lilly’s Zepbound, the list price is roughly $1,100 per month, while the net price is $725.

These new arrangements by Evernorth and CVS Caremark could bring those net prices even lower for employers, just as the government is negotiating Medicare discounts for Novo Nordisk’s Ozempic and Wegovy under the Inflation Reduction Act.

Those Medicare negotiated rates will take effect in 2027 — effectively making Novo Nordisk’s products the preferred drugs in the program. That could see prices come down even further, said Ben Ippolito, senior fellow in health economics at the American Enterprise Institute.

“Once the drug is negotiated, it must be featured on formulary in Medicare. And so that means that if you’re Eli Lilly, you have to try and compete in the Medicare market with a product that’s going to be on formulary and have an artificially lower price. And so it’s going to filter through to what Eli Lilly does,” Ippolito said.

Evernorth’s new weight loss pricing program will begin on July 1, as employers begin to make decisions about coverage for next year’s plans.

— CNBC’s Angelica Peebles contributed to this report.