Ashley Holzworth-Nash spent a decade rising through the ranks at Express Scripts, the pharmacy benefit manager under Cigna’s Evernorth health services division. She began as an account executive in 2014, resolving issues from delayed prescriptions to customer service disputes. The role was financially focused and demanding, matching her strengths at the time.
Two months after returning from maternity leave for her daughter, Brynley, her perspective changed. During a flight home to Pittsburgh following client meetings in Washington, D.C., she sat by the window. The emotions—sadness, anxiety, and a quiet sense of possibility—weren’t about the work itself. They were about whether she wanted to continue in that role.
When the plane landed, she told her supervisor she was leaving the position.
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The move didn’t mean leaving the company. An internal opportunity—and a hiring manager who called her “exactly the person we need”—led to a leadership role in product development. The new job offered a wider view of pharmacy benefits, blending clinical outcomes with cost efficiency. Holzworth-Nash, now vice president of product strategy and solutions, says the shift allowed her to apply years of experience to create something new.
The weight of working in the industry
Her career unfolded as scrutiny of pharmacy benefit managers grew. The industry, led by Express Scripts, CVS Caremark, and Optum Rx, faced criticism for unclear pricing, including rebates and spread pricing that some argued drove up drug costs. For professionals like her, the backlash was difficult to ignore.
Federal reforms, including the Consolidated Appropriations Act of 2026 and settlements with the Federal Trade Commission, required PBMs to adopt clearer models. Express Scripts introduced its Evernorth Signature Pharmacy Benefit Services, which passes drugmaker rebates directly to patients at the point of sale and replaces spread pricing with a cost-plus fee structure. Holzworth-Nash helped design the program.
The changes altered more than just business practices. “It wasn’t hard to operate in the old model because I always knew we were lowering costs,” she says. “But the public perception was tough. Now, the narrative has changed.”
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Before joining Express Scripts, she worked at the University of Pittsburgh Medical Center Health Plan and a Blue Cross Blue Shield affiliate in New York. At Express Scripts, she first managed regional health plans before shifting to product strategy. One of her major projects, MoreThanRx, expands pharmacists’ roles beyond dispensing medication. The initiative pays them for services like disease testing, medication administration, and even prescribing—tasks that can cut costs and improve access.
“Instead of going to urgent care or waiting for a doctor’s appointment, patients can get care right at the pharmacy counter,” she explains. The concept wasn’t originally hers, but she took it from an early stage to its current form, refining the approach and raising awareness among pharmacists and patients.
The COVID-19 pandemic demonstrated pharmacists’ potential as vaccinators, though obstacles remain. “We’ve had to figure out how to reach the right patients at the right time,” Holzworth-Nash says. “It’s not just about offering the service—it’s about making sure people know it exists.”
A transparent future
The FTC settlement with Express Scripts, completed the day after the CAA took effect, included several requirements: ending preferences for high-cost drugs on formularies, basing patient out-of-pocket costs on net prices, and moving its group purchasing organization from Switzerland to the U.S. The company had already launched its new model in late 2025.
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Holzworth-Nash calls the shift both a return to core principles and a step forward. “We’re still focused on getting members to the right outcomes, empowering pharmacists, and lowering costs,” she says. “What’s different is the transparency.” Digital tools now display price options upfront, reducing the surprise that fueled distrust in PBMs.
The industry’s main trade group resisted reforms, pointing to pharmaceutical companies as the source of high drug prices. But Holzworth-Nash views the new model as an opportunity to rebuild trust. “It’s made us think even more about putting the member first,” she says.
On that plane ride two years ago, she wasn’t sure what came next. Now, she knows the work she’s doing is visible, accountable, and aligned with how she wanted to impact healthcare.
