From an aging population and increasing prevalence of chronic disease to the exciting but costly introduction of new drugs, health care is being fundamentally reshaped in the United States. At the same time, consumers today need health care to be more affordable and expect their experiences to be personalized, seamless, and centered on their individual needs.

In a timely conversation on the New York Stock Exchange’s podcast, Brian Evanko, president and chief operating officer of The Cigna Group, shares his take on the pressures facing the U.S. health care system and how The Cigna Group is meeting the moment for patients. Over the course of the 30-minute discussion, Evanko emphasizes that patient-centricity must drive the next generation of health care, and it starts with addressing affordability.

“It’s critically important to build trust with customers and patients – to be a real advocate and a partner to them in their health care journey,” Evanko says. “As we continue to invest in our core businesses, first and foremost we must invest and innovate around the customer and patient.”

Affordability: Health care’s defining challenge

According to Evanko, affordability is the most critical, timely challenge in the U.S. health care system.

Specifically, he pointed to the realities of supply and demand in the U.S. today. First, we have an aging population, increased rates of chronic disease, and a growing need for immediate care are key drivers of rising health care demand. On the supply side, innovation is happening at a rapid pace, but it comes at a high price.

Evanko notes that the median annual list price of a new drug launched last year was $370,000. Hospital consolidation and private equity acquisition-driven price increases further compound the issue.

“Addressing affordability requires new approaches and ensuring customers are at the center of the system,” Evanko says. "These forces together are creating growth rates that are near all-time highs.”

Prescription drug affordability and access can ease system pressure

Evanko notes that while 90% of U.S. prescriptions are filled with generics – often priced more competitively than in other countries – the remaining 10% of brand-name drugs represent nearly 90% of total drug spending.

He identified biosimilars as a key lever to reduce costs. The Cigna Group’s move to introduce $0 out-of-pocket Humira biosimilars has already saved people more than $200 million during the less than two years they have been available. Driving greater use of these lower cost options, he said, represents a significant move in the right direction. He also highlights the rapidly evolving future of pharmacy benefit services. Evernorth recently announced it will transition toward a new rebate-free pharmacy benefit model, which makes discounts negotiated with drug companies available upfront to Americans when they buy their medications at the pharmacy counter.

Evanko explains that while 80% of Evernorth customers pay under $250 annually for prescriptions, the remaining 20% – especially those in high-deductible plans – may face thousands of dollars in costs tied to the list prices set by drug companies rather than negotiated prices.

This new model will cut out the complex post-purchase rebate process and make the discounted price of the drug readily available and transparent from the start.

The goal: transparency, predictability, and affordability for every stakeholder.

Where AI will – and won’t – transform health care

Reflecting on his 27-year career – including assignments across three countries – Evanko emphasizes the value of self-disruption, spotlighting the key opportunity to further advance the use of AI to enhance the health care experience.

AI is a cultural phenomenon on par with the Internet and mobile technology. But clinical applications of generative AI require thoughtful, measured deployment.

He points to a few examples where The Cigna Group is using AI to the benefit of customers and clients:

• Reducing call volume and improving self-service through AI virtual assistants.
• Enabling better first-call resolution by supporting customer service agents in real time.
• Enhancing predictive analytics to identify and support patients who need help earlier.

Human touchpoints remain essential, especially in specialty pharmacy, complex conditions, and face-to-face clinical care, Evanko said, adding that people will always need real human interaction.  

Looking ahead: 2026 and beyond

As The Cigna Group moves through 2026, Evanko says success will be measured by our progress on improving customer and patient experience.

For example, the organization continues its Commitment to Better initiatives to expand affordability, transparency, access, and administrative simplification.

Looking toward 2030, Evanko envisions a company known not only for strong pricing, administration, and clinical programs, but also for differentiated, truly personalized care experiences for every customer.