LAS VEGAS — As drug costs and spending continue to rise, the demand for solutions opens the door to closer collaboration between payers and manufacturers.
Brian Evanko, president and chief operating officer for the Cigna Group, and Miguel Fernández Alcalde, president of EMD Serono, spoke at a keynote session at AHIP 2026 earlier this month, discussing the delicate balance between promoting innovation and ensuring affordability.
The two companies are longtime partners and most recently worked alongside one another on the cost of fertility treatments. Evernorth operates Freedom Fertility, the largest provider of fertility specialty pharmacy services in the U.S., while EMD Serono is a leader in fertility on the manufacturer side.
Evanko said the partnership deepened last year, when both worked with the Trump administration to drive down the cost of certain fertility treatments. Patients can sign up for Trump Rx and find treatments at a cash-pay price of between $1,000 and $1,500, depending on the number of doses in a course of treatment, he said.
"From the very beginning, Cigna Group was this year, with us, being a partner more than a transactional collaborator, and we eventually ended up with something that is huge," Alcalde said. "It's a great example of what can be done if all the parties are looking after the patient.
Both Evanko and Alcalde pointed to the effort as an example of what can be accomplished if drugmakers and payers stand down on the battlefield and instead work collaboratively. Commercial and government plans are all feeling the squeeze from rising pharmaceutical costs, and much of the discussion has focused on who's to blame rather than how to move forward.
Evanko said that innovation and affordability are largely positioned on two sides of the scale, and in the U.S., the emphasis has historically been far more weighted on driving innovation at the expense of affordability.
For example, he said that about 90% of new drugs are immediately available on the market stateside, while in comparable countries that falls to 35%.
"We are not very selective in terms of what makes it to the market, as long as it's proven to be slightly better clinically than a prior drug that's already in existence," he said. "So that dilemma between innovation, access, and affordability to date has been very problematic."
On the other hand, the United States has significant generic drug penetration, as 90% of prescriptions are for generics. The bulk of prescription costs, however, fall in the 10% of brand drugs, he said.
Alcalde said that from the manufacturer's perspective, addressing this balance is also an imperative. If newer models can't come to fruition, the pace of innovation — and the creation of new, life-saving treatments — will ultimately slow.
"If we don't start to make those trade-offs, innovation will not be sustained," he said.
That's where outcomes-based pricing models come in. Evanko said that value-based care in the pharmaceutical space represents an "untapped opportunity," as while some of these contracts exist today, there is potential to significantly expand their use.
For instance, a clear use case is with gene therapies and other treatments that carry price tags in the millions. For many employers, a single worker needing one of these therapies could be devastating financially.
However, they also carry the potential of curing costly and complex conditions. Working with drugmakers to develop contracts based on the outcomes associated with treatment could help soften the financial blow.
But making these relationships work requires engagement with stakeholders beyond the payer or pharmacy benefit manager, and bringing the provider, the patient, government entities and others to the table, potentially, Evanko said.
"There's no one party that's going to solve everything, we know we need to have strong partners — whether it's drug manufacturers, whether it's providers — to bring these things to life," he said.
Alcalde said that given the modern technologies at the industry's disposal, there should be simpler avenues for developing value-based programs in pharmaceuticals, especially as taking a one-size-fits-all approach in this space isn't feasible.
Another element to consider, he said, is when to deploy these models. For some therapies, it may make sense to begin the process of building a value-based arrangement for it while it's still in active development.
"The value is not in the manufacturing side, it's in the R&D," he said. "That is what the value of our whole world lies, and it's not easy to put a value in a drug, but yeah, we have to."