What you need to know

On Friday, May 30, the following communication was shared with health plan clients regarding Evernorth Health Services' (Evernorth) recent announcement of a new glucagon-like peptide-1 (GLP-1) benefit option. To address some client confusion, we want to clarify that this offering is specific to Express Scripts (ESI) pharmacy benefit manger (PBM) clients and does not relate to current Prime Therapeutics' (Prime) benefits or impact the inclusion of EnGuide℠ Pharmacy as a new mail service pharmacy option in Prime client's home delivery network.

What Prime is doing

While this option is not a Prime benefit, we are actively engaged in developing strategies and products for weight management solutions to meet client needs and support affordability, accessibility and customization, while maintaining oversight on GLP-1 utilization and outcomes. 

Currently, our formulary strategy remains accessible (open access) for GLP-1 weight loss products (Wegovy and Zepbound) with specific utlization management (UM) offerings. We continue to work with all manufacturers in this therapeutic area to leverage market trends, flexibility of management and net cost strategies. 

Furthermore, Prime is continuing to refine and develop additional programs through KeepWell™, to mitigate the increasing pharmacy spend and utilization trends of these high-profile products. A few concepts that we are currently evaluating with manufacturers include:

• On-and-off benefit strategy
• Direct future value-based agreements (VBA)
• Utilization of Prime mail as an option (outside of EnGuide)
• Additional flexibility with rebate terms and conditions (UM criteria, lifetime max, copay caps)

As we learn more, we will provide update. Prime's strategy emphasizes choice, control and clinical integrity. By offering both on-and-off benefit options, we aim to meet client and member needs while managing costs and ensuring access to therapies.

Questions?

Please contact your account team representative or email client communications.