Weighing GLP-1 options: How benefits leaders should respond.

As GLP-1s (glucagon-like peptide 1s) fuel the latest surge in pharmacy spending, employers are feeling the squeeze. Traditionally used for diabetes treatment, drugs like Ozempic and Wegovy are now making waves in the realm of weight loss and cardiovascular treatment. As more patients are prescribed GLP-1s, many employers are scrambling to create a strategy that supports their teams and manages costs. Some companies are choosing to provide coverage and others are looking at options and grappling with how they can afford it. With nearly 80% of employers expressing concern about the escalating utilization and its financial implications, it's clear that weight loss drugs are a pressing issue. But why are they suddenly causing such a stir in the pharmacy landscape? Several factors set them apart, making their impact particularly noteworthy.

1. High costs. Prices for GLP-1s can be up to 20 times higher than previous anti-obesity drugs. Some brands retail for as much as $16,000 per year. Wegovy, for example, costs employers between $9,000 and $10,000 per patient per year after discounts and rebates. 

2. Increasing demand. There has been a surge in interest in weight loss drugs, fueled in part by direct-to-consumer advertising, social media, and anecdotal success stories positioning this drug as a miracle weight loss medication. This has led to an increase in individuals seeking these medications from their providers.

3. Broad appeal. The FDA has approved GLP-1s for individuals with a BMI (Body Mass Index) of 30 or higher or a BMI of 27 or higher with comorbidities like high blood pressure or diabetes. With approximately 70% of the US population meeting the coverage criteria, these drugs can be more widely used than most other medications in this therapy class.

4. Growing pipeline. Due to the impressive sales growth of GLP-1s, several pharmaceutical companies are focused on developing alternative medications for weight loss. Over 250 similar drugs are currently being studied.

Adding to the challenge is the fact that these medications are not intended for short-term use. Studies indicate that weight loss is sustained only with continuous drug use, highlighting a long-term investment and a higher price tag for plan sponsors.

Put your benefits philosophy into practice.

Employers must approach the coverage of weight loss drugs in their pharmacy benefit plan the same way they approach their overarching benefits strategy. Ask yourself: How do I think about benefits in general? What is my benefits philosophy? Your philosophy should be the backbone of every benefits decision you make and should be communicated to your teams so they can understand and appreciate the decisions made on their behalf.

Some employers are choosing to focus on alternative weight management strategies instead of covering GLP-1s. This preventive approach includes implementing programs that promote healthy lifestyles and weight management. By encouraging employees to adopt healthier habits, such as regular exercise and a balanced diet, they hope to potentially reduce the need for weight loss medications in the first place. Other employers are choosing to cover GLP-1s as part of their larger health and wellness strategy but are limiting coverage. With this approach, stricter clinical management requirements like proof of diagnosis and step therapy ensure GLP-1s are only approved for employees who actually need the medications and are struggling with covered conditions. This can help reduce the financial impact of covering weight loss drugs while still supporting employees who meet the FDA-approved criteria.

Your stance on weight loss drugs, like any new technology, should be rooted in how you approach other benefits for your team. Whether your goal is to minimize costs, provide comprehensive benefits, or optimize health outcomes, having a strong vision will make it easier to approach disruptors like GLP-1s and other new technologies as they come to market. 

Where your PBM makes a difference.

In order to truly align your pharmacy benefits decisions with your overall benefits philosophy, you must have a PBM partner that caters to your vision. At Rightway, we align with our clients on their approach and help enforce the strategy they want. Additionally, Rightway always makes sure that GLP-1 utilizers meet the clinical criteria. 100% of our members are on evidence-based therapy for weight loss drugs and our high-touch pharmacy teams work one-on-one with these members to identify and switch to alternative drugs and channels to reduce spending. Rightway is committed to driving tangible results that mirror your philosophy, control healthcare costs, and maximize health outcomes for your teams.

Want to master GLP-1 management within your benefits plan? Get in touch with us here.