Ashley Holzworth-Nash, Pharm.D., Evernorth

Ashley Holzworth-Nash, Pharm.D., started with Express Scripts in 2014 as an account executive working with health plans. She had a knack for it, climbing up the sales account management ladder at the company into roles with greater responsibility. Some of the work had a “strategic flair,” she says, coming up with programs that would address problems down the road.

“But a lot of it was financially anchored, a lot of it was operations-based, [and] a lot of it was troubleshooting,” says Holzworth-Nash. “Did the script not get out the door of a pharmacy that we owned? Was there a customer service issue? Do we need different reporting?”

Two years ago, Holzworth-Nash had been back at work for two months after maternity leave for the birth of her daughter, Brynley Nash. She was on a plane headed home to Pittsburgh after client meetings in Washington, D.C., when some powerful feelings came over her that would change
her life.

“We got on the plane, and typically we’d all move our seats so we’d be sitting by each other, but I was content sitting by the window, by a stranger, by myself. I sat there, honestly, and I had this mixture of sadness and anxiety but maybe a little bit of empowerment at the same time to say, ‘My life is changing from a home aspect. I don’t know if I should keep doing account management just because I am good at it and it is what everyone has expected of me,’” recounts Holzworth-Nash. When she got off the plane, she didn’t bury the thoughts. Instead, she told her boss that she didn’t want to do this job anymore.

Sunday was Mother’s Day. Thinking about it over the weekend didn’t change her mind. But because of an opening — and a hiring manager who said, “You are exactly the person we need for this” — what might have been a swerve out of Evernorth, the health services division of Cigna, and its pharmacy benefit manager (PBM), Express Scripts, turned instead into a leadership role in product development at Express Scripts, a job with more of a bird’s-eye view of the company and pharmacy benefits in general.

“I was very lucky, just with what I had done and how folks had known me in the organization, that they allowed me to slot right on over, and it started my journey servicing in our product role, being able to lead our teams, our clients and our members to really better outcomes, both clinically and from an affordability space, and it’s been super exciting to combine, I guess, all that I’ve learned over all the years in my training from back in the day to really be able to produce something very different,” says Holzworth-Nash, whose title is vice president, product strategy and solutions.

Holzworth-Nash, who speaks with bouncy, contagious energy and has a gift for storytelling, has forged a career at Express Scripts at a time when the reputation of PBMs blackened as they came under legal and political scrutiny and criticism as middlemen with secretive, profit-making business practices. Holzworth-Nash says the model of PBMs depending on rebates and spread pricing that has fueled much of the criticism of the three largest PBMs — Express Scripts, CVS Caremark and Optum Rx — occurred because the companies avoided charging administrative fees. PBM reform rules that are part of the Consolidated Appropriations Act, 2026 (CAA) that became law in February, along with settlements with the Federal Trade Commission (FTC), have led to the PBMs creating programs that reflect price rebates from drugmakers at the point of sale and a cost-plus fee structure for pharmacies. Evernorth’s program has named its program Evernorth Signature Pharmacy Benefit Services. Holzworth-Nash was part of the working group that created it. She says she is energized by the new model because it has changed the narrative around PBMs.

“It wasn’t hard to operate in the old model as a pharmacist working here because I always knew we were still working to lower the cost of medications for members and we were still always working on health care,” Holzworth-Nash says. “I think it was hard to work here because of the rhetoric around it. I went to school with a ton of pharmacists. I have a ton of friends who are pharmacists, and we’re all in very different industries. And sometimes you feel like the black sheep. You knew you were doing really well, and you could see the outcomes for your clients. You could see the dollars being saved, but that wasn’t the story. You always felt like you worked in the dark side, regardless of how much good that you saw that you were doing, and that was really hard.”

Loved organic chemistry

Holzworth-Nash, 41, grew up in Monaca, Pennsylvania, a small town on the Ohio River approximately 25 miles northwest of Pittsburgh. Her high school graduating class had 65 people. Her father was in construction, “from a sales perspective or swinging a hammer,” and her mother was on the business side of hairstyling. As a student, Holzworth-Nash gravitated toward math and science, and she wanted to help people. A guidance counselor suggested she observe a pharmacist.

“The first couple of hours I stood there, and the pharmacist was punching in orders and filling prescriptions — it was a local independent pharmacy, and I thought, ‘Why did she send me here? I’m not helping anyone. I’m basically dusting the shelves,’” Holzworth-Nash remembers thinking. But then an older woman with diabetes came in and needed help with her insulin. The pharmacist pivoted from administrative tasks to caring for the woman.

“Just seeing this woman go from being terrified and maybe hopeless to feeling confident and really thankful for her pharmacist helping her, I thought this is why my guidance counselor sent me here,” she says.

Holzworth-Nash thought briefly about pursuing a medical career, but she has an aversion to the sight of blood. At the University of Pittsburgh, she got into the very competitive Pharm.D. program thanks to diligent study habits and a passion for organic chemistry and the plastic models that students use to learn it. “I loved it,” she says. “I could play with models all day long. I think now having a 2-year-old and her playing with Legos really kind of brings it back for me.”

After earning her Pharm.D., Holzworth-Nash worked for the University of Pittsburgh Medical Center Health Plan and then for what was then called HealthNow New York, a Blues plan headquartered in Buffalo, New York, before getting hired by Express Scripts as a client account executive. As one of the three largest PBMs, Express Scripts serves clients that run the gamut of the U.S. healthcare system. The clients that Holzworth-Nash tended were regional health plans.

Holzworth-Nash says one of her main accomplishments in her current product strategy role is the MoreThanRx program that created ways for pharmacists to be reimbursed for providing services beyond dispensing medication. There’s state-to-state variation in what pharmacists are allowed to do, but Holzworth-Nash says MoreThanRx is designed to tap into the unused capacity of pharmacists, including administration of some types of medication, testing for some diseases and even prescribing. Moving services to pharmacies does double duty, she says, both saving money and adding convenience and access to healthcare.

“Instead of going to urgent care and spending more healthcare dollars there or calling and trying to get an appointment at your doctor, we’re actually designing a process to allow pharmacists to do that for patients right at the counter,” she says. The idea for MoreThanRx did not originate with her, but Holzworth-Nash says she “took it pretty much from infancy to make it exactly what it is today.”

The program has been refined to add more services. Marketing efforts have increased awareness. Pharmacists became identified as vaccinators during the COVID-19 pandemic, but challenges with vaccination remain, she says. “We’ve had to think through how we interact at the right moment with the right patients to direct them to the right pharmacies.”

A new model

The PBM reforms and regulations in the CAA and FTC settlements — Express Scripts signed its FTC settlement the day after President Donald Trump signed the CAA into law — were not a surprise, Holzworth-Nash says. The working group she joined had begun meeting the previous year. The group understood, she says, that the rules governing PBMs were fundamentally changing. “I remember our president saying, ‘You need to come up with a model you can ride out your careers on. The last one lasted 30 years; we want this next one to last more than 30 years’ — essentially saying this was not a temporary shift but the future of the business.”

Among the provisions of the FTC settlement are requirements that Express Scripts stop preferring high wholesale acquisition cost (WAC) versions of a drug over identical low WAC versions on its standard formularies; that its standard offering ensure that patients’ out-of-pocket expenses will be based on the drug’s net cost; that compensation from drugmakers be “delinked” from list prices; and that the company reshore Ascent, its group purchasing organization, from Switzerland to the United States. Express Scripts unveiled its Signature Pharmacy Benefit Services model months before, in late 2025.

Holzworth-Nash talks about both constancy and change. “We’re still focused on getting members to the right healthy outcomes. We’re still focused on empowering pharmacists. We are still focused on getting members to the lowest-cost therapies and helping members navigate their benefits,” she says. What has changed is price transparency and the availability of digital tools that present patients with price options and what they can expect to pay at the counter. “Generally, we know that hasn’t happened and we know a lot of consumers have had surprises, and that’s led to a lot of inability to like or, dare I say, just to have a certain dislike for pharmacy benefits,” she says.

The main PBM trade group waged a campaign against PBM reform and the new rules, pointing a finger at the pharmaceutical industry as the culprit behind high prices. But Holzworth-Nash sees benefits from what she says is “a transparent, affordable, forward-focused, innovative” model for managing prescription drug costs and delivery.

“It’s made us think about the member in the center even more than we ever had before,” says Holzworth-Nash. She is hoping that refreshed reorientation will translate into successful efforts to change member behavior and foster greater trust in PBMs.

When Holzworth-Nash talks about the emotions that welled up on the plane ride back to Pittsburgh two years ago, that career-changing episode comes to life. She speaks with equal force about what she sees as a new era for the industry in which she is carving a successful career.

“I’m happy that I maybe don’t feel like the black sheep in the room because I feel like PBMs are in a different place,” says Holzworth-Nash. “We’re still anchored to the mission that I came to this company 12 years ago to do, to help patients, to help members and to lower drug costs. It’s just now in a transparent way where I think folks feel that we are more trusted — or at least someone that they don’t view as negatively as before.”