Washington, D.C. – the site of Evernorth Health Service’s 2024 Outcomes conference – is the epicenter of federal government, a fitting setting for a gathering designed to explore how to solve the biggest challenges in health care, said Adam Kautzner, president of Evernorth Care Management and Express Scripts.
As he spoke about the prescription drug landscape, Kautzner touched on glucagon-like peptide 1 (GLP-1) agonists, originally approved to treat diabetes and now FDA-approved for weight loss, and biosimilar medications, which are creating competition among biologic drugs, then previewed the future of gene therapies and upcoming therapies for rare diseases.
GLP-1s: Soaring popularity highlights the value of PBMs
Over the past year or so, the conversation around using Ozempic and other GLP-1s for weight loss has moved from the doctor’s office to pop culture, with icons from Oprah to The Real Housewives making Ozempic a household name and sparking important health conversations about weight, appropriate patient access, drug shortages, and more.
These are life-altering treatment options for people living with obesity, diabetes, and cardiovascular diseases, and many people who need these medications are struggling to ensure they have consistent access. The popularity of these drugs has made GLP-1s the top trend driver for plans so far this year, and their market is likely to exceed $100 billion by 2030.
“That’s where our supply chain excellence and our clinical expertise are able to come together as an organization,” Kautzner said. EncircleRx, a portfolio of cardiodiabesity solutions, now includes the industry’s first GLP-1 financial guarantee. Lifestyle modification is part of the program, which helps people stay on their medications and drives better overall outcomes.
Biosimilars: Competition and patience will drive deeper savings
Humira, which treats inflammatory conditions, is one of the top selling drugs of all time. “Humira has increased in price by over 40% in the last five years, an unsustainable rate,” Kautzner said.
When Humira lost its patent exclusivity last year, Evernorth worked behind the scenes, utilizing its expertise and not rushing to bring a solution to market prematurely even as Evernorth’s formulary committees acted quickly to review new options. Today, the supply of Humira biosimilars exceeds demand, and by contracting with multiple manufacturers, Evernorth can provide flexibility and ensure sufficient supply.
“I’m proud to say that Evernorth is now able to provide an interchangeable biosimilar for Humira. It’s going to be available at Accredo at $0 patient-out of-pocket,” he said. “We are also able to provide significant savings for plan sponsors.” The net cost for sponsors will be under $1,000 – saving thousands of dollars each month per patient.
Oncology drugs, gene therapies, and more
Specialty drugs – especially oncology medications and gene therapies – are the fastest growing part of the drug pipeline, Kautzner said.
“Many patients aren’t benefiting from the latest innovations in treatment,” he said. “Evernorth offers guided oncology care and a second opinion service, and we’re continuing to iterate and build new solutions to help improve therapy access for patients and make sure they’re on the right therapy.”
About 1,000 gene therapies are in the pipeline, and Express Scripts expects as many as 20 new therapies could be approved in 2025 alone. They are launching at premium prices that have the potential to stress total health care budgets, including a recently approved hemophilia B product priced at $3.5 million. “We’re investing in this space to develop new solutions, so you’re not caught off guard by these multimillion-dollar therapies,” he said.
Express Scripts is also monitoring the development of specialty drugs for rare conditions with high unmet needs. For example, the FDA recently approved the first treatment for metabolic dysfunction-associated steatohepatitis (MASH), which is the most severe form of fatty liver disease.
Experts estimate about 1.5% to 6.5% of U.S. adults have MASH today, but those numbers are expected to climb along with skyrocketing rates of chronic liver disease. One niche product has been approved, and Evernorth is watching the space closely.
