Cigna’s Shift to Net Drug Pricing: Why Transparency Alone Isn’t Enough for Plan Sponsors

Scripta
7 days ago
3 min read

Cigna’s announcement that Evernorth will move away from traditional manufacturer rebates and toward up-front, net drug pricing reflects a broader industry reckoning: opaque pricing models are no longer sustainable in a healthcare environment under intense cost scrutiny.

For HR and benefits professionals, this shift is welcome. Net pricing promises clearer visibility into drug costs and a more straightforward financial model. But transparency—on its own—does not guarantee better outcomes.

As rebate-driven incentives fade, plan sponsors are left with a more important challenge: how to turn clearer pricing into better decisions, better utilization, and better results for members. That’s where execution matters.

The Pricing Shift Creates Clarity—And a New Gap

By removing rebates from certain commercial plans, Cigna aims to ensure members pay the lowest available price at the pharmacy counter, particularly benefiting those in high-deductible health plans. It also reduces reliance on back-end financial reconciliation, giving plan sponsors a cleaner view of pharmacy spend.

But even with up-front net pricing:

Members still face complex choices between brands, generics, biosimilars, and cash-pay options
Prescribers may not have visibility into plan-specific cost differences
Employers still struggle to influence behavior at the moment decisions are made

In other words, transparency reveals the problem—but it doesn’t solve it.

Why Rebate-Free Pricing Increases the Need for Navigation

As rebates diminish, savings will no longer come from hidden offsets. They will come from better decisions made earlier—by members, prescribers, and care teams.

This puts pressure on plan sponsors to:

Drive adoption of lower-cost therapeutic alternatives
Accelerate biosimilar uptake
Reduce avoidable specialty drug spend
Improve adherence and avoid abandonment

These outcomes don’t happen through pricing structures alone. They require real-time, personalized guidance that meets members where they are—before high-cost utilization is locked in.

This is precisely where Scripta adds value.

How Scripta Turns Net Pricing Into Real Savings

Scripta’s Rx Navigation platform is designed to complement transparent pricing models—not compete with them.

By integrating directly with existing benefit designs and PBM structures, Scripta helps plan sponsors act on cost insights, not just observe them.

With Scripta, employers can:

Identify lower-cost, clinically appropriate alternatives for high-impact drugs, including brands, generics, and biosimilars
Guide members at the point of decision, before prescriptions are filled or refilled
Support prescribers with actionable recommendations, reducing friction and delays
Improve adherence by helping members afford and stay on their medications
Measure savings based on net cost outcomes, not rebate assumptions

In a rebate-free environment, this kind of navigation becomes essential. Without it, plan sponsors risk seeing transparent pricing—but missing the opportunity to influence utilization.

Specialty Drugs: Where Transparency Matters Most—and Isn’t Enough

Specialty drugs remain the largest and fastest-growing driver of pharmacy spend. And they are also where pricing clarity alone has the least impact.

Even with net pricing:

Biosimilars may go unused
Members may default to hospital-based infusions
High-cost therapies may persist without reevaluation

Scripta addresses this gap by:

Flagging specialty alternatives and site-of-care opportunities
Supporting transitions to lower-cost therapies when clinically appropriate
Engaging members with personalized outreach that explains options in plain language

This is where rebate-free pricing and navigation must work together.

What HR and Benefits Leaders Should Do Next

Cigna’s move is not just a pricing update—it’s a signal that the rules of pharmacy cost management are changing.

Plan sponsors should ask:

Do we have visibility into net drug costs and utilization behavior?
Can we influence decisions before spend occurs?
Are members supported in making affordable, clinically sound choices?

In a world with fewer rebates, the value shifts from financial complexity to execution.

The Bottom Line: Transparency Is Powerful—When It’s Activated

Cigna’s move to up-front, net drug pricing is a clear signal that pharmacy benefits are becoming more transparent and more accountable. But transparency alone doesn’t change outcomes.

For HR and benefits leaders, the next phase isn’t about replacing PBMs, redesigning plans, or adding operational complexity. It’s about ensuring the benefits strategy you already have actually works in practice—at the moment members and prescribers make decisions.

That’s where Scripta delivers differentiated value.

Scripta operates as a seamless overlay to existing pharmacy benefits, integrating directly with current PBM arrangements, plan designs, and pricing models—including net pricing structures. Rather than introducing another siloed solution, Scripta activates the benefits employers already pay for by turning cost visibility into personalized, actionable guidance.

In a rebate-free environment, success will depend less on financial mechanics and more on execution—guiding members to affordable, clinically appropriate medications, improving adherence, and reducing avoidable spend without disruption.

Transparency sets the stage.

Navigation drives the results.

Scripta connects the two.