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The Senate Finance Committee voted 14-13 along party lines this morning to send the nomination of Robert F. Kennedy Jr. to be HHS Secretary to the full Senate.

Updated: RFK Jr. To Get Vote Before Full Senate

Peter Wehrwein has been the lead editor of Managed Healthcare Executive since February 2020.

The Louisiana Republican, who led a hepatitis B vaccination campaign before entering politics, has expressed concerns about Robert F. Kennedy Jr's views on vaccines.

Senate Finance Committee Is Set To Vote on RFK Jr. This Morning, All Eyes Are on Cassidy

This follows the company’s recent earnings call, where executives discussed the organization’s growth and future plans, highlighting its focus on serving the best interests of their consumers.

Cigna Reveals Multi-Year Plan to Simplify Healthcare, Boost Transparency and Improve Patient Support

Potential threats to HIV care and fallout over the next four years, according to Jose Abrigo, Esq., HIV project director at Lambda Legal Defense and Education Fund and Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.

The HIV Epidemic in Trump’s America

Managed Healthcare Executive provides C-suite executives at health plans and provider organizations with news, analysis, insights, and strategies to pursue value-driven solutions.

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Chief scientific officer, ADoH Scientific

The Cigna Group released their revenue report for 2024 which showcased their 27% revenue jump to $247.1 billion — with Evernorth much to credit.

Evernorth, which includes pharmacy benefit services such as Express Scripts, contributed to the increase that clocked in at $195.3 billion in 2023.

David M. Cordani, chairman and CEO of The Cigna Group, highlighted Evernorth’s contributions during a conference call discussing the results.

“Evernorth continues to drive strong results in line with our expectations, primarily driven by our specialty and care services segment,” Cordani said.

The numbers highlight this statement, with pharmacy benefit services reaching $111.8 billion in adjusted revenue, a 46% jump from $76.8 billion in 2023.

Cigna's 27% Revenue Increase in 2024 and the Outlook on 2025

In addition, specialty and care services recorded $90.3 billion in adjusted revenue, marking an 18% increase from the previous year.

Evernorth's growth pattern has remained consistent, establishing itself as the backbone of Cigna’s financial performance.

As Cordani noted, Evernorth's leadership in biosimilars plays a crucial role in addressing major healthcare challenges.

For instance, the company introduced the Humira interchangeable biosimilar last summer, offering eligible patients access at $0 cost. 

By the end of 2024, nearly 50% of eligible Humira prescriptions were filled with biosimilars, and Evernorth is now extending this benefit to the interchangeable Stelera biosimilar.

Over the next five years, Cordani said approximately $100 billion in specialty drug spend in the U.S. will be subject to biosimilar and generic competition, positioning Evernorth to lead the way in delivering significant savings.

He also emphasized the growing need for affordable prescription drugs, especially with the rising use of GLP-1 medications, which have become a major driver of drug spending trends.

While these medications are relatively inexpensive to produce, U.S. patients are paying several times more than those in other countries, even with full pass-through rebates.

By advancing biosimilars and working to reduce drug costs, Evernorth remains committed to ensuring that patients can access medications at fair prices while maintaining long-term sustainability in the healthcare system.

Eric Palmer, president and CEO of Evernorth Health Services, highlighted in a 

, the organization's continued innovation in response to market demands.

"We know that healthcare and prescription drugs need to be more affordable, and coverage needs to be more transparent and less complex," he said.

To further enhance affordability, Evernorth has recently introduced several initiatives focused on cost transparency and patient protections.

These protections ensure that patients benefit directly from the savings Express Scripts negotiates.

For example, patients will no longer pay the high list prices for medications, and those in high-deductible plans will receive the lower prices negotiated by Express Scripts, even during the deductible phase when costs can be highest.

Beyond price protections, Evernorth is increasing transparency by offering personalized reports to patients, detailing their prescription drug costs, negotiated savings and plan-paid amounts.

Plan sponsors will also receive detailed, annual reports that provide greater visibility into pharmacy claims and costs than what is typically offered.

These efforts are part of Evernorth's larger strategy to make healthcare more affordable and transparent for all involved.

Adam Kautzner, president of Evernorth Care Management and Express Scripts, stressed that these initiatives are designed to ensure there are no surprises at the pharmacy counter.

A key factor in Evernorth’s innovation is the data-driven EncircleRx program, which expanded to cover about 8 million lives in 2024, Cordani added.

The program helps plan sponsors reduce costs and improve outcomes, with its Cardiodiabesity solution offering predictability in managing obesity, diabetes, and cardiovascular disease.

It also provides lifestyle support and tools to help patients on GLP-1 medications sustain long-term improvements.

Cordani expressed the importance of these solutions, especially given the rising costs of GLP-1 medications in the U.S.

"Despite these medications being relatively cheap to produce, Americans are paying prices that are multiples higher compared to other countries," he said. "This is not acceptable, nor sustainable."

Formulary Watch

Clinical

Evernorth Drives Cigna's Strong Revenue Growth and Focuses on Biosimilars and Drug Affordability

When President Donald Trump nominated Robert F. Kennedy Jr. as his choice for HHS secretary, many health experts were left scratching their heads — and more  — because of what they see as large catalogue of beliefs that are contrary to science. This morning, Kennedy is scheduled to sit for the first of two Senate hearings when senators will question him about those beliefs and decide whether to vote for his confirmation.

The HHS secretary is a big job to do, to put mildly. The department encompasses all of the federal government's health agencies including Centers for Disease Control and Prevention, National Institutes of Health, the FDA and CMS. 

The senators on the Senate Finance Committee may quiz Kennedy today about this leadership and managerial experience, but the spotlight is likely to be trained on his statements connecting 

, the dangers of fluoride, and COVID-19 and race. 

Although they have received less attention than his views on vaccines, Kennedy has also staked out controversial positions on the HIV and AIDS. 

When it comes to HIV policy, one of Kennedy’s biggest targets is Anthony Fauci, M.D.,  the former head of the National Institute of Allergy and Infectious Diseases. Kennedy attacks Fauci relentlessly in his 934-page book,

 “The Real Anthony Fauci: Bill Gates, Big Pharma and the Global War on Democracy and Public Health

," co-published in 2021 by the Children's Health Defense, an antivaccine group that Kennedy led. "Readers of these pages will learn how in exalting patented medicine, Dr. Fauci has, throughout his long career, routinely falsified science, deceived the public and physicians, and lied about safety and efficacy," Kennedy wrote in the forward.

In the fifth chapter of the book, titled "HIV Heresies," Kennedy writes several times that he is neutral on the whether HIV causes AIDS. "From the outset I want to make clear that I take no position on the relationship between HIV and AIDS," he says at the beginning of the chapter. Later on, though, Kennedy says in a parenthetical passage that he believes that HIV is "a cause of AIDS" and there are numerous mentions throughout the chapter of HIV infection not being the sole cause of AIDS. 

Despite assertions that he is not taking sides, Kennedy spends much of the chapter on HIV presenting arguments made by Peter Duesberg, a molecular biologist at the University of California, Berkeley, and perhaps the most influential HIV "denier." Duesberg has argued that HIV does not cause AIDS but is a "free rider" common to high-risk populations who suffer immune suppression due to environmental exposures. 

” Kennedy sums up Duesberg’s theory as follows:

“Duesberg and many who have followed him offered evidence that heavy recreational drug use in gay men and drug addicts was the real cause of immune deficiency among the first generation of AIDS sufferers. They argued that the initial signs of AIDS, Kaposi’s sarcoma and 

pneumonia (PCP), were both strongly linked to amyl nitrate—poppers—a popular drug among promiscuous gays.”

Duesberg's views have been rejected by AIDS experts and advocates. Kennedy, though, accuses Fauci of cutting off scientific investigation and debate about the relationship between HIV and AIDS and instead using his "frightening capacity to silence dissent and mangle reputations." 

After a brief resurgence of HIV-denial in the early 2000s, there was a lull until the COVID-19 pandemic, which stoked mistrust in public health and vaccine hesitancy, observed Tara C. Smith, Ph.D. a professor at the Kent State University College of Public Health, in a review article about HIV denialism published in October 2024 in the journal 

Kennedy debuted his own antivaccine views in a 2005 

,” which was also published in Salon online, according to  Smith. Within days, inaccuracies about false claims about connection between vaccines and autism were pointed out. Salon 

 the article from its website permanently in 2011. Kennedy went on to fund Children’s Health Defense. 

During the COVID-19 pandemic, Kennedy called the COVID vaccine “the deadliest vaccine ever made,” while 

 Louisiana lawmakers at a meeting of the House Committee on Health & Welfare.

Injectable lenacapavir is an antiviral, not a vaccine, but when used as  preexposure prophylaxis it has the same public health purpose as a vaccine, preventing infection and serious disease. The investigational, twice-yearly antiretroviral, has created quite the 

, with investigators reporting an almost 100% success rate at preventing HIV in clinical trials when compared to placebo.

Some HIV experts are wary about the future of lenacapavir, HIV policy and care access if Kennedy is confirmed as HHS secretary. As part of its freeze on foreign aids, the Trump administration has already moved to cut off support of the  President's Emergency Plan for AIDS Relief, a global health that is credited with curtailing the AIDS epidemic, especially in Africa. 

[Kennedy’s] going to do,” Jose Abrigo, J.D., HIV Project Director of the Lambda Legal Defense and Education Fund said in recent an interview with 

“Lenacapavir could either be covered under the Advisory Committee on Immunization Practices (ACIP) or be covered under the US Preventive Services Task Force, which is preventative care, period," Abrigo said. "Which government body will make that recommendation strategically so that it won’t raise RFK’s hackles and his anti-vaccine beliefs?”

Because most HIV research programs are federally funded, it’s possible that budget cuts will be made.

“President Trump, in his last term, established the Ending the HIV Epidemic initiative and funded it. We don't know what the second term is going to bring,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in an interview with 

You can't take away healthcare from people living with HIV," Schmid continued. "It is a lifetime requirement and unfortunately, we don’t have adequate private insurance programs or adequate Medicare programs to ensure that people have the care, treatment and support services to make sure they stay adherent to their medications. I think everything's on the table right now, and that's our job is to educate the new administration, educate the new Congress about the value of HIV prevention, research, testing, treatment and PrEP.”

In 2021 book attacking Anthony Fauci, M.D., Robert F. Kennedy Jr. casts doubt on HIV being the sole cause of AIDS and presents arguments made by "HIV deniers" that believe it is bystander in the immunosuppression that characterizes AIDS.

RFK Jr. and HIV Denial: He Says He Is Neutral, But...

The FDA has approved Celltrion’s similar of Genentech’s Actemra (tocilizumab). Celltrion’s Avtozma (tocilizumab-anoh) will be available as both an intravenous (IV) and subcutaneous (SC) formulations to treat patients with rheumatoid arthritis, giant cell arteritis, juvenile idiopathic arthritis and COVID-19.

Avtozma pricing will be finalized closer to the commercial launch as the company continues to engage with stakeholders, including payers and healthcare providers, according to a company spokesperson.

The FDA's decision is based on the totality of evidence, including the results from a phase 3 study demonstrating biosimilarity between Avtozma and reference tocilizumab in patients with moderate to severe active rheumatoid arthritis. The primary endpoint was met in terms of change from baseline in disease activity score and the final one-year results supported comparability in secondary efficacy, pharmacokinetic, safety and immunogenicity results between Avtozma and reference tocilizumab.

Avtozma is Celltrion's seventh biosimilar granted marketing authorization in the United States and is the third biosimilar of Actemra to be approved by the FDA. Fresenius Kabi’s Tyenne (tocilizumab-aazg) in both IV and SC formulations was approved in March 2024, and in September 2023, the FDA approved Biogen’s IV formulation biosimilar, Tofidence.

Actema and the three biosimilars are interleukin-6 (IL-6) receptor antagonists that target specific inflammatory proteins to suppress the immune system.

The average monthly cost of Actemra administered via IV ranges from about $2,308 to $4,616, depending on which dose a person receives, a Genentech spokesperson told 

 last year. The average monthly cost of Actemra administered subcutaneously ranges from about $2,478 to $4,956 depending on how frequently a person takes it, the dose varies depending on the person’s weight.

The new biosimilar, Celltrion’s Avtozma, was approved in both IV and  subcutaneous forms to treat inflammatory conditions such as arthritis.

Brian Sullivan, Psy.D.

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