Adam Kautzner, PharmD, president of Evernorth Care Management and Express Scripts and EVP of Customer Personalization at The Cigna Group, moderates a discussion on the evolution of pharmacy benefits with AJ Ally, RPh principal and pharmacy management consultant at Milliman, and Alysha Fluno, PharmD, national pharmacy practice leader at Marsh
What employers need from pharmacy benefits
Employers want pharmacy benefits that control costs without making coverage more difficult for patients to use. “Affordability is in the forefront of employers’ minds,” said Alysha Fluno, national pharmacy practice leader at Marsh. She said employers are also looking for greater transparency, simplicity, and predictability.
Those priorities align with findings from research conducted by Penta Group, on behalf of Evernorth Health Services, that found employers increasingly favor pharmacy benefit models that make costs easier to understand, improve spending predictability, and help lower medication costs for consumers.
AJ Ally, principal and pharmacy management consultant at Milliman, said employers are increasingly interested in models that provide greater confidence in how pharmacy dollars are spent while helping patients reach lower-cost options more easily.
How Evernorth Signature is evolving pharmacy benefits
“Pass-through pricing, cost-plus arrangements, and point-of-sale rebates are not new,” said Ally. “But the rebate-free model, where manufacturer value is delivered directly at the pharmacy counter, is new.” Signature includes a rebate-free approach that delivers manufacturer value directly at the pharmacy counter rather than months later through rebates.
That distinction matters because employers are increasingly looking for models that align incentives across stakeholders. Ally pointed to the importance of demonstrating value creation and managing pharmacy trends while controlling costs, noting that aligned incentives between PBMs and plan sponsors are likely to become an increasingly important differentiator.
Fluno said that employers are showing strong interest in exploring alternative approaches. “Clients are curious,” she said. “This is a pivotal time because now we have a large PBM [in Express Scripts] leaning into that type of model with scale and market presence that we have not seen before.” Fluno also described the market as entering a “fast followers” phase as more employers evaluate new approaches.
What will set future pharmacy benefit models apart?
Ally identified three capabilities that will distinguish pharmacy benefit models in the years ahead: operational efficiency, the ability to manage spending across pharmacy and medical benefits, and the ability to demonstrate value through savings, better experiences, and improved clinical outcomes.
Fluno highlighted another differentiator: combining transparent pricing with the scale, clinical expertise, and operational capabilities needed to improve affordability and outcomes.
The discussion also touched on the next wave of affordability challenges facing employers. As prescription spending grows and client expectations evolve, employers will need flexible solutions that support affordability, clinical appropriateness, and access.
Employers are also seeking greater predictability for people with complex conditions, who often have multiple conditions and treatments that interact across multiple providers, settings, benefits, and decisions. Prescription drugs account for half of the costs associated with complex patients, underscoring the importance of models that make medication costs easier to understand, manage, and predict.
The bottom line
For employers, the opportunity is to gain greater predictability without sacrificing plan spend, while helping consumers pay less at the pharmacy counter. Evernorth Signature Pharmacy Benefit Services is designed to deliver that balance through greater transparency, predictability, and simplicity.
Learn more about Evernorth Signature Pharmacy Benefit Services at Pharmacy Benefits Upgrade for Everyone.
Quotes have been edited slightly for clarity.
