As part of its investor day on Thursday, Cigna's Evernorth arm announced an expansion to its GLP-1 management solution as well as the launch of a new behavioral-health-focused medical group.
Evernorth's Express Scripts segment launched EncircleRx in response to the growing demand for these therapies and the challenges plan sponsors and clients were facing in addressing the costs. Now, the program will offer an industry-first financial guarantee, which allows for greater predictability in the cost associated with covering these drugs.
Adam Kautzner, president of Express Scripts, told Fierce Healthcare that GLP-1s are currently the No. 1 driver of drug spend, and it's forcing many employers to rethink their coverage options, even if they ultimately want to provide access to these therapies.
"I think that these drugs have become, I guess I would call them a cultural phenomenon that we haven't seen before," he said. "With that, it has created much more demand among patients as well to be able to access these medications."
Evernorth noted in the press release that costs related to "cardiodiabesity" encompass about $719 billion each year. Along with the financial guarantee, Express Scripts offers lifestyle coaching and other supports to assist them with weight loss and management of their chronic needs.
Patients who are eligible to take a GLP-1 drug are also enrolled in Omada's lifestyle modification program, which drives behavioral change. The program can include digital scales and other virtual tools members can use to manage their weight at home.
Kautzner said the guarantee aspect adds "peace of mind" for clients who were facing major hurdles in addressing the cost of GLP-1s.
"It brings the best of what we do to our clients," he said.
In addition to the expansion to EncircleRx, Evenorth unveiled its new Behavioral Health Care Group, an outpatient behavioral health practice that it says can expand access to millions of people. The medical group offers services both virtually and in person and guarantees that within 72 hours, a patient can secure a visit with a clinician matched to their preferences.
The group's clinicians have a lower administrative burden and, as such, are "empowered to focus on patient care."
Eva Borden, president of behavioral health at Evernorth, told Fierce Healthcare that the medical group aims to address multiple key goals, including access. The team is also looking to put a focus on value-based care, and the Behavioral Health Care Group will participate in Evernorth's behavioral health management program.
There are challenges to expanding measurement-based care into behavioral health, as much of the data are self-reported and can be difficult to track. Plus, traditional practices are quite small, which can make it hard to convene a broad swath of data to generate insights.
"For far too long, the behavioral health space has actually lagged the medical space in the concept of measuring outcomes," she said.
Boosting access to behavioral health can generate significant value, she said; if an individual in need secures three outpatient visits, it can reduce their medical costs by 20% on average.
The medical group is launching with 1,000 licensed clinicians who can address a variety of needs, including parenting support, grief management and relationship counseling. The team worked alongside Octave to build out the practice, and Borden said it was a critical partner in standing up technology and bringing down administrative burden.
"Evernorth Behavioral Health is focused on connecting the behavioral health ecosystem," Borden said. "This is just another way that we're really thinking about how we can do that."