Evernorth is committed to building solutions that make health care better, finding innovative ways to surround patients with specialized clinical care and help plan sponsors manage high-costs, unstable access, and fragmented outcomes. As scientific advancements lead to more groundbreaking – and expensive – therapies, the need for comprehensive solutions is becoming an even greater imperative. In the case of GLP-1s (glucagon-like peptide-1), this need is no exception – in fact, it’s paramount.
GLP-1s offer significant promise to millions of Americans living with obesity, diabetes and/or cardiovascular disease, but their unprecedented demand and high price tags are creating challenging downstream impacts including fluctuating supply, inconsistent clinical support, and runaway cost trajectory. As the list of indications for these therapies continues to expand and current market dynamics persist, these challenges will only be further exacerbated.
Evernorth first began addressing the unique issues facing GLP-1 patients and plan sponsors with the launch of Evernorth EncircleRx. EncircleRx includes a financial guarantee that protects plans from the sharply rising cost curve of GLP-1s, and supports patients through a clinically proven lifestyle modification program with behavior change support designed to help them achieve and maintain improved health outcomes.
Now, Evernorth is further expanding its GLP-1 suite of solutions through the creation of a new program called Evernorth EnReachRx. EnReachRx is a high-touch patient support clinical model enabled by pharmacies committed to enhanced clinical care for dispensing GLP-1 prescription medications, integrated throughout the patient journey, and backed by optimized drug spend management.
Additionally, as part of EnReachRx, Evernorth is bringing to market a new home delivery pharmacy called Evernorth EnGuide Pharmacy, powered by CHD. Focused on dispensing GLP-1 drugs, the pharmacy will be staffed by clinicians with specialized knowledge in GLP-1s who will provide enhanced guidance and education support to patients. Where available, EnGuide Pharmacy will help connect patients to manufacturer copay assistance options they may be eligible to receive.
“The current model for GLP-1 access and care is not optimized for patients, the pharmacies stocking these medicines or plan sponsors covering them,” said Ashley Holzworth-Nash, PharmD, vice president, retail network product strategy and solutions, Express Scripts Pharmacy Benefit Services. “Through EnReachRx, we have created a full patient support journey, from ensuring the right patients are receiving these medications to supporting the patient with specialized clinical care, to ensuring the most value is being achieved by plan sponsors.”
The EnReachRx model includes three core focus areas:
- Driving value: EnReachRx includes dose optimization support; enhanced fraud, waste, and abuse detection and interventions; and navigation through side effect management. All these measures, and more, aim to remove waste and improve patient outcomes, contributing to an improved overall total cost of care.
- Maintaining reliable GLP-1 access: All pharmacies participating in EnReachRx – including retail pharmacies across the country and EnGuide Pharmacy – will dispense both 30-day and 90-day GLP-1 prescriptions, subject to members’ plan design. Ensuring members have access to GLP-1s is critical to supporting them through their health care journey.
- Improving patient outcomes: Patients prescribed a GLP-1 can greatly benefit from enhanced clinical support including dose management, adherence monitoring, educational resources, and more. Pharmacists are in a unique position within the health care system to provide this support throughout each patient’s care journey. All participating pharmacies in EnReachRx will deliver this enhanced clinical support and will receive a professional service fee for doing so.
“Our expanded suite of solutions reinforces our continued leadership in helping all stakeholders navigate the GLP-1 landscape,” said Holzworth-Nash. “Innovation is part of our DNA at Evernorth, and we will continue advancing new solutions to make health care better for all.”
The EnReachRx suite of solutions will be available beginning in June 2025.
Listen to our Health Unscripted podcast below for a deep dive into the challenges and opportunities within the GLP-1 landscape.
