Cigna's $3.5 Billion 340B Play, Novo Expands DTC, Congress Adopts Billion-Dollar “Orphans”

Hey all,

Happy Hump day! Today’s stories all point to the same truth: pharmacy has become the easiest lever for squeezing out better margins. Cigna is shifting from contract work to in-house specialty pharmacy with its $3.5B Shields deal, Novo is cutting PBMs out of the loop with its new direct-to-consumer model for Wegovy, and Congress carved out exemptions for rare-disease drugs so pharma could keep charging sky-high prices. Different strategies, same playbook—pharmacy is where the money gets made.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Healthcare Dive) Cigna’s Evernorth $3.5B Investment in Shields Specialty Pharmacy

Cigna’s health services arm Evernorth has invested $3.5 billion in Shields Health Solutions, a former Walgreens-owned specialty pharmacy business, to deepen its reach into one of the fastest-growing and most profitable areas of healthcare. Specialty drugs, though used by less than 5% of Americans, now drive more than half of U.S. pharmacy spend, making Shields’ hospital-focused pharmacy model a lucrative expansion opportunity for Cigna’s Express Scripts unit and Evernorth’s broader care services. But sure, this is all about “serving patients” — not just plugging the hole left after drugmakers gutted 340B contract pharmacy revenues with lawsuits. Full Article

(STAT News) Novo Nordisk links Wegovy patients to telehealth providers

Novo Nordisk has begun directing patients seeking its obesity drug Wegovy to telehealth providers through its NovoCare website, deepening the trend of drugmakers selling directly to consumers via branded online portals. This move mirrors efforts by Eli Lilly and Pfizer, who are also partnering with telehealth companies to streamline access to prescriptions while raising scrutiny from lawmakers concerned about potential conflicts of interest and prescribing incentives. Of course, Novo’s fashionably late entrance into the pharm-to-table movement feels more like catch-up than innovation — and it had better sharpen its digital game fast before rolling out its upcoming semaglutide pill. Full Article

(Health Affairs Forefront) Medicare Negotiation & Orphan Drugs

A new analysis warns that recent changes under the One Big Beautiful Bill Act (OBBBA) significantly expand exemptions and delays for rare disease drugs in Medicare’s price negotiation program, potentially eroding expected savings. While these provisions were intended to sustain investment in orphan drug development, many such products now generate blockbuster-level sales, particularly in oncology, and their protected status could cost Medicare tens of billions as manufacturers adjust strategies to preserve exemptions. Future legislation may need to rethink whether exempting billion-dollar “orphan” drugs truly fosters innovation—or just leaves us with breakthroughs no one can afford. Full Article