Cigna's Evernorth caps out-of-pocket cost for Wegovy and Zepbound at $200

Cigna's pharmacy benefit manager, Evernorth, announced on May 21 a new arrangement with drugmakers Novo Nordisk and Eli Lilly that caps patient out-of-pocket costs at $200 a month for Wegovy and Zepbound ^[1][2]. The program is aimed at employers who currently don't cover the drugs because of their price, according to Harold Carter, Evernorth's senior vice president of pharmacy relations ^[1].

Right now, only about half of Cigna's clients cover the GLP-1 weight loss drugs at all, largely because of cost ^[1]. Some employers that already offer coverage charge workers copays as low as $25 a month, but for those sitting on the sidelines, a $200 cap would still come to less than half of what patients pay in cash through the manufacturers' direct-to-consumer websites ^[1]. The $200 payments would count toward a patient's deductible ^[2].

The deal also brings a simplified prior-authorization process and consistent pricing whether a patient fills the prescription at a retail pharmacy or through Evernorth's home delivery service ^[1]. Carter said employers already covering the drugs could see costs drop by up to almost 20% under the updated arrangement ^[1]. Cigna would not disclose the specific discounts it negotiated, but analysts told CNBC that large employers and insurers have generally secured discounts of 30% to 50% off list price ^[1].

List prices remain high: Wegovy lists at $1,350 a month and Zepbound at roughly $1,100 ^[1]. But net prices — what actually gets paid after rebates and discounts — were lower as of March, according to an analysis by the Institute for Clinical and Economic Review cited by CNBC: $616 for Wegovy and $725 for Zepbound ^[1]. In clinical trials, the two drugs produced 15% to 20% reductions in body weight ^[2].

The Evernorth move follows a similar step by CVS Caremark, which said in April it would make Wegovy its preferred weight-loss drug starting in the second half of 2025, a shift that would push Zepbound out of preferred status in that plan ^[1]. Novo Nordisk declined to comment on the new pharmacy benefit arrangements; a Lilly spokesperson said the company would keep working with health care, government and industry partners on ways to help people with obesity access Zepbound ^[1].

Why it matters for patients

For people whose employer plans don't currently cover Wegovy or Zepbound, this program does not create coverage by itself — it's an option Evernorth is offering to employers, who still decide whether to adopt it ^[1]. If an employer signs on, workers using either drug could see monthly costs capped at $200, compared with cash prices that a January study found averaged $549 for Zepbound and $650 for Wegovy with a manufacturer discount card ^[2].

The timing also matters because the FDA's policy allowing pharmacies to sell compounded copies of these drugs during shortages ended May 22, the day after this announcement ^[2]. That cutoff removes a cheaper option some patients had been using, from companies like Hims & Hers, Noom, Weight Watchers and Ro, making manufacturer pricing and insurance coverage more central to what patients actually pay ^[2].

What happens next

Evernorth's new pricing program is set to begin in the second half of 2025, timed to when employers are choosing benefits for the following plan year ^[1]. Separately, Medicare is negotiating prices for Ozempic and Wegovy under the Inflation Reduction Act, with those negotiated rates set to take effect in 2027 ^[1]. Ben Ippolito of the American Enterprise Institute told CNBC that once a drug is negotiated, it must appear on the Medicare formulary at that lower price, which could pressure Lilly to compete on price for Zepbound as well ^[1].