Cigna To Cap Zepbound and Wegovy Copays at $200. Rare Win for Patients or PBM Survival Mode?
- Dave Knapp
- 5 days ago
- 3 min read
Cigna just dropped its opening bid in the next round of the GLP-1 access war. Through its Evernorth unit, the insurer says it will soon offer a new pricing structure for both Wegovy and Zepbound, capping patient out of pocket costs at $200 a month. This is not a savings card. This is a built-in copay ceiling baked into the plan. And to be fair, that deserves some credit.
However, the implementation of this copay cap depends on individual employer decisions. Employers must choose to adopt this new pricing structure for their health plans. Therefore, while the initiative has the potential to benefit many, its actual reach will vary based on employer participation.
But when patients are forking over $500 for cash pay treatments each month, or turning to compounding pharmacies or grey markets just to survive, getting a flat copay near the cost of compounded GLP-1s is progress. $200 dollars is still fairly high for many Americans, but it’s closer to what people were paying before the crackdown. For that, Cigna and pharma do earn a nod for getting this done. They are moving in the right direction.
But let’s not pretend this was done out of compassion.
Pharmacy benefit managers and big pharma alike are facing heat. Reform efforts are stacking up at the state level and in Congress. Lawsuits are piling up. Industry practices are under a microscope. And even the POTUS, who last week signed a sweeping executive order, has taken public jabs at the prescription drug pricing and the pharmacy “middlemen”. That means PBMs are running out of runway.
Cigna knows it. And this move from Evernorth feels like a bid for goodwill. A strategic play, not just to win headlines, but to survive. Because if PBMs want to keep their role in the system, they have to start looking like they are part of the solution.
This comes right on the heels of CVS Caremark naming Wegovy its preferred drug, knocking Zepbound off the top shelf in many plans. Rather than follow suit, Cigna structured their deal to cover both drugs equally. It keeps the field level for now, and positions Evernorth as a PBM offering flexibility rather than restriction.
It also comes at a time when the door to mass-compounded GLP-1s is slamming shut. Tebra is pulling support for clinics prescribing 503A custom compounded GLP-1’s. The FDA is escalating its posture. And patients are being pushed back toward the branded drugs with fewer and fewer options. That makes this $200 cap look like a lifeline, even if it’s a self-serving one.
There is also Medicare. In 2027, the first round of negotiated prices under the Inflation Reduction Act will take effect. Wegovy will be included. Zepbound will not. That creates pressure for Eli Lilly to shore up commercial market share while it still can. These new deals give them a platform to do it.
So yes, patients may get some relief. And yes, this is a better offer than we have seen from most any insurers to date. But let’s not confuse smart optics with moral clarity.
PBMs are trying to stay in the game. They know the tide is turning. And this move from Cigna is not a pivot. It is a shield.
The real question is whether this is the beginning of a new model for coverage or just a distraction while the system tries to clean up its image.
For now, we will take what we can get.
We are not done watching. And we are not done pushing.