As demand for GLP-1 skyrockets, employers are struggling to pay for these expensive drugs for their employees.
That’s why the Peterson Institute for Health Technology, an independent evaluator of digital health solutions, recently released a guide for employers on GLP-1 coverage. It noted that many employers are turning to virtual solutions to help manage budgets and improve employee outcomes in relation to GLP-1. The guidance shows that virtual solutions can help employers manage the three phases of GLP-1 coverage:
- Initiation: Provide limited GLP-1 coverage to support those most likely to benefit. This includes a narrow prescriber network and the need for alternative weight loss programs as step therapy
- Maintenance: Maximizing clinical benefit by improving medication adherence and outcomes (e.g., through lifestyle changes and managing side effects)
- Support discontinuation: Help maintain weight loss after stopping GLP-1, including behavioral support to reduce weight regain
Virtual solutions fall into two main categories: comprehensive programs that include weight loss prescriptions and comprehensive programs that focus on lifestyle support while employees can get their prescriptions elsewhere.
Based on employer experience, supplier data and expert interviews, PHTI offers five key recommendations for employers seeking to design sustainable GLP-1 coverage:
1. Employers should develop clear, clinically driven eligibility criteria for coverage and use virtual programs to implement these criteria. They should also prioritize patients with the greatest potential clinical and economic impact, such as those with a higher body mass index.
2. Employers should require participation in a behavioral, nutritional, or lifestyle modification program to obtain coverage. Mandating that members complete a lifestyle change program will help improve outcomes and identify patients who are committed to long-term weight loss.
3. Companies should provide structured support for patients tapering or discontinuing GLP-1 therapy. Those recovering from addiction often gain weight back, so it is important to provide ongoing access to the “non-drug components” of virtual solutions.
4. Employers should analyze the capabilities of existing vendors before adding additional point solutions. This will reduce duplication, simplify staff navigation and integrate GLP-1 management into broader chronic care services.
5. Companies should contract with suppliers using outcome-based contracts to align costs with long-term performance and strengthen GLP-1 coverage standards.
“Employers face a dilemma between employee demand for highly effective medications and the financial realities of providing them to potentially a large portion of their workforce,” PHTI executive director Caroline Pearson said in a statement. “The GLP-1 market is evolving faster than traditional benefit planning cycles, with new pricing models, direct-to-consumer options and virtual solutions rapidly emerging. This report provides employers with an evidence-based approach to help them make informed decisions that balance access with sustainability.”
Photo: Jason Dean, Getty Images
