In the latest episode of the “Health Unscripted” podcast, Evernorth Health Services and Express Scripts care management president Adam Kautzner joins host Ashley Holsworth-Nash, vice president of network product strategy at Express Scripts, to discuss a groundbreaking shift in pharmacy benefits services. The episode spotlights Evernorth’s recent announcement of a new model designed to deliver upfront drug discounts and performance-based pharmacy reimbursement.
Immediate savings and transparency
Kautzner explains that the new model eliminates the traditional, complex rebate process, making negotiated drug discounts available directly at the pharmacy counter. Patients will see cost savings immediately, especially for brand-name drugs, he says. The move aims to simplify the experience for patients, increase transparency, and improve medication adherence by lowering out-of-pocket costs.
Performance-based pharmacy reimbursement
The episode also highlights Evernorth’s commitment to supporting independent and community pharmacies. Under the new model, pharmacies will be reimbursed based on actual medication procurement costs and can earn additional payments for meeting clinical quality metrics and providing extra services, such as health screenings. Pharmacies in critical access areas will receive higher dispensing fees, recognizing their essential role in rural communities.
Impact on plan sponsors
Under the new model, plan sponsors (employers and unions) will benefit from real-time visibility into drug costs, which is essential for anticipating trends and managing expenses. In addition, streamlined administrative processes and a simpler fee structure make benefit management easier. With lower upfront medication costs leading to better adherence and improved patient outcomes, the new model is expected to build plan sponsors’ confidence in the value of prescription treatments, which helps strengthen trust in the health care system.
Industry implications
Looking ahead, Kautzner believes that greater transparency will become the norm in the health care industry, with pharmacy reimbursement evolving to reward clinical outcomes and service quality. He also says that pharmacy benefit managers will increasingly serve as strategic partners, leveraging data and clinical expertise to drive affordability and access.
As the industry moves toward value-based care, the new Express Scripts model marks a pivotal step toward shaping future standards for pharmacy benefits that prioritize transparency, collaboration, and whole-person health.
The new Express Scripts reimbursement model is expected to launch in 2027.
