Evernorth Announces Industry-First Financial Guarantee For GLP-1 Spend

EncircleRx solution now includes financial predictability for health plan sponsors to help expand access for appropriate patients.
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ST. LOUIS, Mo., March 7, 2024: Evernorth Health Services, a subsidiary of The Cigna Group (NYSE: CI), announced the industry’s first financial guarantee for clients interested in covering GLP-1s. By providing financial predictability, this expansion of Evernorth’s EncircleRx program allows companies and health plans to better manage GLP-1 spend through a cost cap or savings guarantee, which in turn helps ensure access for appropriate patients.

“Our industry-first financial guarantee offers employers and health plans greater predictability and control of their GLP-1 spend,” said Adam Kautzner, president of Express Scripts and Evernorth Care Management. “EncircleRx also gives clients access to our deep insights and clinical expertise to help ensure GLP-1s are accessed by patients who need them most – whether it’s to control their diabetes or achieve a healthier weight. Our clinically proven lifestyle modification program, coupled with GLP-1s, surrounds patients with support to help them achieve the best possible outcomes.”

Cardiodiabesity – the confluence of obesity, diabetes, and cardiovascular disease – represents about $719B in annual health care costs. EncircleRx is a data-driven solution that gives health plans optionality to help their members manage these conditions and the other health issues that commonly accompany them. Through deep supply chain expertise, Evernorth has established unique agreements that enable EncircleRx to support patients who will benefit the most from a combination of medication and lifestyle modifications while also providing plans with greater control and predictability over the cost of GLP-1 therapies.

In addition to a financial guarantee that protects plans from the sharply rising cost curve of GLP-1s, EncircleRx offers employers and health plans access to Evernorth’s insights and clinical expertise. Patients who meet the criteria for a GLP-1 are also enrolled in a clinically proven lifestyle modification program with behavior change support from an Omada Health care team, designed to help them achieve and maintain improved health outcomes – whether that is controlled A1C, weight loss, or reducing cardiovascular comorbidities.

Study: Digital health tools complement GLP-1 use

Omada Health recently partnered with the Evernorth Research Institute to understand the relationship between GLP-1 use and lifestyle change support. The pilot program focused on members participating in Omada for Prevention, a virtual lifestyle program providing personalized support. These members had a baseline weight and at least one follow-up weight, checked monthly. 

Participants who used GLP-1s and were more engaged in Omada for Prevention lost more weight than those who used these medications and were less engaged in the program. Additionally, the study found: 

  • Omada for Prevention supports those taking GLP-1s in adopting sustainable behavior changes for greater weight loss success. 
  • Relationship-based engagement – for example, working closely with a care team or fellow program participants – drove more success than other forms of engagement. 
  • Other examples of program engagement include posting on peer discussion boards, completing lessons, and tracking meals, weight, and other metrics.

About Evernorth Health Services 

Evernorth Health Services creates pharmacy, care, and benefits solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention, and treatment of illness and disease more accessible to millions of people. Evernorth capabilities are powered by our businesses, including Express Scripts, Express Scripts® Pharmacy, Accredo, eviCore, and MDLIVE, along with holistic Evernorth platforms and solutions that move people and organizations forward. All Evernorth solutions are serviced and provided by or through operating affiliates of Evernorth Health, a wholly owned subsidiary of The Cigna Group (NYSE: CI), or third-party partners. Learn more at evernorth.com

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