Evernorth's Perlberg bullish on $400B specialty pharmacy market

Evernorth Health Services sees expanding opportunities in the $400 billion specialty pharmacy market, said Matt Perlberg, president of pharmacy and care delivery for the Cigna subsidiary.

Cigna identified specialty pharmacy as a target for accelerated growth this year, and the future is bright as more of these high-cost drugs reach the market to meet rising patient demand, Perlberg said.

Related: Elevance, Cigna, CVS accelerate push into specialty pharmacy

Specialty pharmacies dispense drugs to treat conditions such as rheumatoid arthritis, Crohn's disease and cancer, provide clinical support to patients, and require unique storage and handling capabilities. CVS Health, Elevance Health and Walgreens also made specialty pharmacy plays in 2024.

Evernorth includes the specialty pharmacy Accredo, which treats about 1 million patients annually, and specialty distributor CuraScript, which serves more than 12,000 providers. In addition, the company partners with CarepathRx to provide specialty pharmacy and infusion services on behalf of providers.

Evernorth, which also houses pharmacy benefit manager Express Scripts, delivered more than 80% of the $181.5 billion in revenue Cigna generated through the first nine months of 2024. Evernorth revenue shot up 31.4% compared with the first three quarters of 2023.

In an interview, Perlberg discussed Evernorth's goal to alleviate the financial burden of specialty drugs and how biosimilar alternatives to brand-name biologic pharmaceuticals fit into the picture.

This interview has been edited for length and clarity.

What’s behind the boom in specialty pharmacy?

One big trend we see coming in specialty is the increased demand for those medications, and that's fueled by a wave of complex drug innovations. Last year, about 70% of the drugs that were approved by the [Food and Drug Administration] were specialty drugs, and we expect that growth to continue. Increasingly, we will see specialty drugs come to market for rare diseases, like hemophilia, and I would expect that to continue into next year.

We're really excited about the innovation in the specialty space. ... Only about 2%-3% of the population has a specialty condition, yet they account for about half of all drug spend.

What does that mean for the healthcare system?

As the specialty market continues to grow rapidly fueled by that drug innovation, it does create challenges across that ecosystem.

For patients, they want access to those medications, and they need help navigating their healthcare journey. For employers, they want to provide access to those medications and do so affordably. For healthcare providers, they want to make sure patients are getting the care they need, and that the medications they're prescribing work as intended.

At Evernorth, we sit at the intersection of all those needs. We have a suite of solutions, through Accredo, CuraScript, CarepathRx and more to serve the needs of these stakeholders.

How does Evernorth aim to promote access?

There are several things we do at Accredo, both to provide clinical care to patients as well as ensure that patients have access to those drugs. A hallmark of our clinical model at Accredo is our Therapeutic Resource Centers.

We have 15 Therapeutic Resource Centers, where our clinical teams, pharmacists, nurses, dietitians and social workers specialize by disease state. That allows us to provide specialized care to patients, and do so nationwide. ... A really good example of this is our nurses. We have a team of over 600 field-based infusion nurses. Over 90% of our patients live within one hour of one of our nurses. Unlike most of our competitors, we employ our nurses directly, which gives us a much more coordinated level of patient care.

Because these drugs are so complex, manufacturers will often choose one or a limited number of partners to treat patients on their product. ... We have access to over 98% of the specialty drugs by volume on the market today. That is more than any one of our competitors.

How important are biosimilars?

Expanding access to biosimilars is a key area of innovation for us.

Earlier this year, Evernorth made the biosimilar for Humira available at our specialty pharmacy Accredo with no out-of-pocket cost for eligible patients. Already, more than one-third of those eligible patients have chosen the biosimilar, and we expect that to grow in 2025. We expect that, on average, patients will be able to save $3,500 per year.

We also announced that starting early next year we’ll make a biosimilar for Stelara available at Accredo at no out-of-pocket cost for eligible patients. We expect to save patients $4,000 per year, on average.

We’re still in the early innings of biosimilars in this country. We expect, by 2030, about half of the top 25 specialty drugs will face competition from a generic or biosimilar. ... There are lots of opportunities for us to create savings for patients and plan sponsors with biosimilars and generics through the end of the decade.

What is Evernorth doing to support patients?

Patient care is front and center to everything we do in the specialty space. We have specialized clinicians who help take care of patients. We help patients secure access to copay assistance for their medications. To the extent that they have clinical questions about their medications, we support that.

We have over 30 care delivery sites, which is one of the largest footprints in the industry. ... We also have, across the United States, four highly sterile clean room environments where we can safely mix some of the most complex drugs. Most pharmacies don’t have a clean room.

Why is Cigna so focused on specialty pharmacy?

Specialty is a large, fast-growing space. It’s one in which we are the leader. If you look at the healthcare landscape, drug spend makes up maybe over 25% of the total cost of care. In the next 10 years, that will be more than 40% of the total cost of care. That’s fueled by this wave of complex drug innovation, particularly in the specialty space.

Specialty medications have a huge impact on people’s lives. We see that firsthand everyday, and we’re uniquely positioned to help care for those patients.