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

Cigna's pharmacy benefits unit, Evernorth, announced on May 21, 2025 that it will offer employers a program capping members' monthly out-of-pocket cost at $200 for the weight-loss drugs Wegovy (semaglutide) and Zepbound (tirzepatide) ^[1][2]. The cap is an add-on to pharmacy benefit plans, meaning an employer has to choose it ^[2].

Harold Carter, Evernorth's senior vice president of pharmacy relations, said the arrangement targets employers that do not cover the drugs today. About half of Cigna's clients currently cover Wegovy and Zepbound, Cigna said ^[1]. "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," Carter said ^[1]. The $200 figure is per month ^[1].

Many Evernorth clients already offer the drugs with copays as low as $25 per month ^[1]. For employers that have held back on cost grounds, Cigna said a $200 cap amounts to less than half what consumers pay in cash without insurance if they buy through Eli Lilly's or Novo Nordisk's direct-to-consumer websites ^[1]. Reuters reported that people without insurance paid an average of $549 for Zepbound bought directly from Eli Lilly, while those using a Novo Nordisk discount card paid $650 for Wegovy ^[2].

Evernorth said the deal also includes a simplified prior authorization process and the same price at retail pharmacies or through its home delivery service ^[1]. Employers already covering the drugs are included, and Carter said those clients could see "up to almost 20% a reduction" in their costs ^[1].

The two sources describe list prices differently. Wegovy lists for $1,350 per month and had an average net price of $616 in March, according to an analysis by the Institute for Clinical and Economic Review, while Zepbound lists for roughly $1,100 per month with a net price of $725 ^[1]. Reuters described list prices that reach $1,000 but said the drugs are available for about half that or less on the manufacturers' websites ^[2]. Cigna did not disclose the discounts it negotiated ^[1]. Analysts say large employers and other insurers have received between 30% and 50% below list price ^[1].

Novo Nordisk would not comment on the pharmacy benefit arrangements ^[1]. 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" ^[1].

The announcement followed CVS Caremark's decision last month to make Wegovy its preferred weight-loss drug starting in the second half of the year, which would mean Zepbound is no longer preferred ^[1].

Why it matters for patients

Whether the $200 cap applies depends on the employer, not the patient. The program is an option employers can add to their plans, so two people with Cigna-administered pharmacy benefits could face very different costs ^[2]. Evernorth has not disclosed which employers have signed on ^[1].

A $200 monthly cap is still a recurring cost, separate from premiums. Carter said the $200 copays would count toward a patient's deductible, the amount a plan requires patients to pay before it covers expenses ^[2].

Cost has been the main reason employers limit coverage: Cigna said only about half of its clients cover Wegovy and Zepbound ^[1]. In clinical trials, the drugs led to a 15% to 20% reduction in body weight, according to Reuters ^[2].

The change does not affect Medicare. The government is separately negotiating Medicare discounts for Novo Nordisk's Ozempic and Wegovy under the Inflation Reduction Act ^[1].

What happens next

Evernorth's program begins in the second half of 2025, as employers make coverage decisions for next year's plans ^[1].

CVS Caremark's preferred status for Wegovy also starts in the second half of the year ^[1].

The Food and Drug Administration's policy allowing compounded copies of the drugs ends May 22, 2025 ^[2]. Noom said last week it would continue selling smaller doses of the medication after that date ^[2].

Medicare's negotiated rates for Ozempic and Wegovy take effect in 2027, which analysts say could pressure prices further ^[1].