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Luke Hansen, M.D., M.H.S., is the chief medical offficer of Arcadia, a healthcare data analytics compnany.

Navigating Medicare Advantage in 2025: Strategies for Success Amid Uncertainty

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.

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

 The impact of psoriatic arthritis (PsA) differs widely between genders, several studies show.

In the most recent research, published online in 

 last month, found that disease activity, physical disability, functional limitation, depression and anxiety scores were higher among women with PsA than amone men with the disease. The researchers reported that quality of life and Psoriasis Area and Severity Index (PASI) scores were higher in male patients.

The study of more than 1,000 patients with PsA at 25 centers in Turkey zeroed in on patients with “axial” PsA, a recognized categorization of PsA that means the disease affects the spine, hips and shoulders in contrast to the “peripheral” PsA, which affects the arms and legs).

Pain score, fatigue, quality of life, anxiety, depression, and other scores were significantly worse in females than males with axial PsA. However, quality of life was better and PASI scores were worse in men than in women, the research team led by Kemal Nas of Sakarya University.

“This study has shown that the burden of disease in axial PsA has significant difference between genders. Therefore, we suggest that new strategies should be developed for more effective treatment of axial PsA in female patients,” wrote Nas and his colleagues.

Nas was the lead author of a previous study exploring gender differences among people with PsA that was also published in 

. That 2017 study found that women with PsA had higher symptom duration and body-mass indexes than men with the disease.

“Men with PsA are more likely to have higher PASI scores and longer duration to develop arthritis after the onset of psoriasis, while women are more likely to have higher disease activity and report more fatigue and physical activity limitations,” says the abstract.

Not all of Nas’ findings have pointed to differences between the sexes. In the 2017 study, for example, Nas and his colleagues found that that quality of life, extra-articular features (including uveitis and iritis), family history of PsA and the rates of spondyloarthritis and ankylosing spondylitis were very similar among both men and women.

Research documents that the disease affects men and women differently.

The Difference Gender Makes in Psoriatic Arthritis

Human metapneumovirus (HMPV) is a respiratory virus that may not be on most folk’s radars, but it’s more common than you think — and chances are, you’ve already had it.

A recent “outbreak” in northern China has brought HMPV into the spotlight, raising questions about its significance.

Frank Esper, M.D., a pediatric infectious disease specialist at Cleveland Clinic Children’s Hospital, provides his insights into this virus.

HMPV is similar to common respiratory illnesses such as colds, the flu and respiratory syncytial virus (RSV). Its symptoms include coughing, wheezing, a runny nose and a sore throat.

Although most cases are mild, certain groups — including young children, older adults and those with weak immune systems — face a higher risk of developing severe illness.

, children under five are especially vulnerable due to their developing immune systems.

First discovered in the Netherlands roughly 24 years ago, HMPV belongs to the same viral family as RSV.

Esper, who helped discover the virus during his fellowship at Yale-New Haven Hospital, noted that HMPV likely existed and infected humans for hundreds of years, however, the tools and technology to detect these viruses have only become available in the last few decades.

As “sister” viruses, HMPV and RSV share many characteristics.

Both cause upper and lower respiratory tract infections and can lead to conditions such as viral pneumonia and bronchiolitis.

In children, airway inflammation may result in wheezing and difficulty breathing. Adults with chronic lung conditions, such as asthma or COPD, are also at risk for complications.

Esper shared that while symptoms of the two viruses are similar, their seasonal occurrence differs. RSV typically surges in December and January, while HMPV is more common in March and April.

“They (HMPV and RSV) have a very sophisticated dance,” Esper said. “So, it's not just temperature, but it also has to do with immune priming — about when the susceptibility is.

“There's a lot that goes to when the seasonality of a virus (is). Temperature is one of those parts, but there's actually more than that. They work together somehow, we haven't figured out how.”

Accurate diagnosis requires molecular tests like PCR to detect the virus’s genetic material.

As far as spreading, HMPV travels through large respiratory droplets.

Close contact with an infected person, touching contaminated surfaces and then touching your face can lead to infection. The virus primarily affects the nasal passages but can spread to the lungs in severe cases, potentially causing pneumonia.

Preventive measures such as frequent handwashing, covering coughs and avoiding close contact with sick individuals are encouraged to limit its spread.

For mild cases, HMPV symptoms typically resolve within a few days to a week. More severe infections may take longer to improve and could leave lingering symptoms like a persistent cough.

There are no specific antibiotics to treat HMPV, so it’s encouraged to let the body fight it off on its own.

For mild cases, getting plenty of rest and drinking lots of fluids is usually enough. In more serious cases, people might need to go to the hospital for extra oxygen or help managing other health issues such as asthma or COPD.

Esper explained that the immune system is very important for getting better, and most people feel back to normal within three to five days.

“Your immune system, for the most part, is all you need,” he said. “You just need the time to weather the storm, and that's what we do from a treatment standpoint. A lot of the time, you don't need any medical treatment.”

The long-term effects of HMPV are still being studied, he mentioned.

While early-life RSV infections have been linked to asthma, there is currently no evidence of similar long-term complications from HMPV, Esper said. Most folks recover fully without lasting issues.

To reduce the risk of HMPV infection, it’s encouraged to follow these hygiene practices:

First discovered in the Netherlands roughly 24 years ago, HMPV belongs to the same viral family as RSV. 

Luke Hansen, M.D., M.H.S.

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