FOR AGENT/BROKER USE ONLY. DO NOT DISTRIBUTE.
EncircleRx: Preparing for Foundayo’s anticipated diabetes indication
Review the changes to EncircleRx and implications for members due to upcoming FDA approval of Foundayo™ for type 2 diabetes.
Preparing EncircleRx for anticipated diabetes indication
Foundayo is expected to receive FDA approval for a type 2 diabetes indication later this year. EncircleRx developed a layered approach to help ensure members using Foundayo for type 2 diabetes are not subject to the lifestyle modification vendor engagement requirement that applies to members seeking Foundayo for weight loss treatment.
EncircleRx Weight Loss includes a process to identify members using Foundayo for type 2 diabetes and exempt them from the vendor engagement requirement. To further minimize the risk of disruption, clients can choose an optional approach that removes the vendor engagement requirement for all Foundayo prescriptions. All members continue to be evaluated through the prior authorization process to ensure appropriate use.
Previous updates
Evernorth EncircleRxSM has announced Zepbound®, FoundayoTM and Wegovy® (oral and injectable) for chronic weight management in adults is now included within the EncircleRx weight loss programs.
In addition, we expanded cost flexibility by allowing a member cost share of up to $150 per 30-day prescription for Zepbound, Foundayo and Wegovy (oral and injectable) for the EncircleRx weight loss programs.
A commitment to increasing affordability for clients and members
As the oral GLP-1 landscape evolves, Evernorth® will continue to closely monitor new developments and keep you informed.
Additional notes:
Clients currently enrolled in our Highly Automated PA offering will still have a cost share of up to $200 per 30-day prescription for Zepbound, Foundayo and Wegovy (oral and injectable)
This does not apply to the Vendor+ restricted provider network solution
Evernorth EncircleRxSM: Cardiodiabesity, part of our GLP-1 management suite of solutions, gives plans more optionality when managing cardiodiabesity, the interconnected conditions of obesity, diabetes and cardiovascular disease.
EncircleRx offers clients a pathway to better support the overall health and wellness of plan members in a way that suits their needs and budget and is sustainable.
To address a growing trend of direct-to-consumer GLP-1 purchases, EncircleRx offers a highly automated utilization option for weight loss. This option focuses on the lowest plan net cost per prescription and keeps member copays at no more than $200 for Zepbound® and Wegovy®—lower than current direct-to-consumer offerings on the market.
What you need to know:
Highly Automated PA is for clients who do not currently cover weight management drugs and want to bring these members back into the benefit while managing the unit cost of GLP-1s (vs trend)
Client participation in Evernorth EnReachRxSM not required
Includes enhanced fraud, waste and abuse support to ensure appropriate prescribing and dispensing of GLP-1s
Optional holistic condition management through lifestyle modification tools offered at no cost to the member
No financial guarantees are available
