Cigna is adding new price caps and transparency models through its pharmaceutical benefit manager, Express Scripts.
According to an April 13 news release, Cigna will offer a "copay assurance model," capping members' monthly copays at $5 for generic drugs, $25 for preferred brand-name drugs and $45 for preferred specialty drugs.
The new transparency models come as PBMs are facing more scrutiny from lawmakers. In March, the House Committee on Oversight and Accountability opened an investigation into three PBMs, including Express Scripts, for alleged anti-competitive practices.
Lawmakers have also introduced bills aimed at ending "spread pricing," a practice in which PBMs charge payers higher rates for drugs than they reimburse pharmacies.
Cigna will also add an option for health plans, employer and government contracts to pay a flat fee for pharmacy benefit administration, with 100 percent of rebates Express Scripts negotiates passed on to clients.
The price caps and "ClearCareRx" option, which eliminates spread pricing, will be available in summer 2023.
In 2024, Express Scripts will add a pharmacy benefits statement for consumers, explaining drug price costs and out-of-pocket costs.