Navigating the Shift: Employer-Led Demands Reshape Pharmacy Benefit Management

A major transition is underway in the U.S. pharmacy benefit sector as corporate employers increasingly abandon traditional rebate-based structures in favor of transparent, fee-only models. Recent data from the Penta Group indicates that nearly 90% of U.S. employers are now actively seeking pharmacy benefit management (PBM) agreements that bypass legacy rebate systems to ensure that negotiated drug savings are passed directly to plan members.

This structural pivot is largely motivated by the urgent need for predictability as medication utilization reaches record levels, with roughly 66% of the U.S. adult population managing at least one prescription.

Penta Group’s latest research points to a clear change in how employers are thinking about pharmacy benefits. A large share of U.S. organizations now appear to favor more transparent, rebate-free models, including approaches like the one introduced by Evernorth.

Most respondents said these models make drug pricing easier to understand. Many also found them more intuitive than the systems currently in use. In addition, about nine in ten employers believe removing rebates would improve employee satisfaction and help make medications more affordable. Nearly 87% said these models fit their business priorities better, while 86% expect them to give employers more control and predictability over pharmacy spending.

This shift also reflects broader pressure across the U.S. healthcare system. As the population ages, demand for prescription drugs is rising, and by 2030, one in five Americans is expected to be 65 or older. At the same time, roughly two-thirds of U.S. adults take at least one prescription medicine, increasing the need for benefit designs that are easier to navigate and more transparent.

Introducing Signature Pharmacy Benefit Services Cigna Healthcare

Designed for a modern healthcare climate, the Signature Pharmacy Benefit Services model focuses on the following pillars:

• Transparency: Plan sponsors receive deeper insights into medication costs, supported by clear acquisition pricing, robust auditing processes, and independent verification.

• Simplicity: The system moves away from tangled, network-dependent rebate schemes to a straightforward fee-based structure that is entirely separate from drug price fluctuations.

• Predictability: By utilizing fixed fees and providing clear visibility into manufacturer value at the point of adjudication, the model creates a reliable financial framework that is simple to verify and evaluate.

• Affordability: Negotiated savings are passed directly to the pharmacy counter, lowering out-of-pocket costs for workers, particularly for brand-name prescriptions, which drive nearly 90% of total pharmacy spend.

Cigna Healthcare plans to roll out this service for fully insured commercial accounts starting in 2027, with a broader transition for all Evernorth clients scheduled for 2028.