In a significant move for the U.S. pharmaceutical and payor landscape, Evernorth the health services arm of The Cigna Group announced a sweeping redesign of its pharmacy benefit services that could have profound implications for HTA, market access and drug pricing dynamics.
A bold pricing pivot at the pharmacy counter
On October 27, 2025, Evernorth revealed a “rebate-free” pharmacy benefit model whereby negotiated discounts on brand-name medicines will be made available upfront to patients at the point of sale eschewing the traditional manufacturer-rebate-to-PBM-plan-sponsor flow. For fully insured lives under Cigna, the model will roll out in 2027, and become standard for all Evernorth pharmacy benefit clients in 2028.
Traditionally, PBMs (pharmacy benefit managers) negotiate rebates with manufacturers, which then partly flow back to payors or are used to offset premiums and patients rarely benefit directly at the pharmacy counter. Evernorth’s model instead promises that patients will pay “the lowest of” negotiated net price, cash discount, or other pricing options with brand-name prescriptions projected to drop by ~30% at the pharmacy counter for those paying full cost.
This changes the calculus in several ways:
- Pricing transparency: With discounts visible up-front, payors and HTA bodies may require more explicit justification for list versus net pricing, as patients begin to see benefits at the point of care.
- Value proposition re-framing: Drug manufacturers may need to adjust launch pricing or rebate strategies, since patient out-of-pocket burdens may fall and payors may demand stronger health-economic modelling and outcomes evidence to justify price point.
- Budget-impact and reimbursement modelling: As more patients gain lower prescription cost access, payors will assess longitudinal impact (adherence, outcomes, downstream savings) and may revisit cost-effectiveness thresholds and access tiers accordingly.
This announcement by Evernorth may act as a catalyst across the industry: other PBMs, payors and pharma stakeholders may replicate or respond. Commentary suggests the move targets the so-called gross-to-net bubble (where list prices inflate while net discounts remain opaque). As patients see net pricing directly, the importance of pricing justification, real-world outcomes and long-term value becomes more acute.