Overview
- Cigna will move roughly 2 million fully insured members to a rebate-free, point-of-sale model in 2027, with the approach becoming the standard option for Express Scripts clients in 2028 while rebate-based arrangements remain available by choice.
- Evernorth will implement cost-plus reimbursement across all in-network pharmacies starting in 2026, paying pharmacies their drug cost plus a dispensing fee and additional payments for clinical services.
- The company estimates people who pay full price for brand-name drugs, including many in high-deductible plans, will see about 30% lower monthly costs under the new pricing model.
- Technology at the pharmacy counter will automatically compare negotiated rates, cash discounts, direct-to-consumer offers, and copays so customers are charged the lowest available price and have spending count toward deductibles.
- Executives framed the shift as aligned with regulatory pressure on PBMs; the plan excludes Medicare and Medicaid benefits, and Evernorth targets about 50% employer adoption within three years.