Considering Covering GLP-1s? Here’s What You Need to Know

Employer healthcare costs are expected to increase by 9% next year, with pricey pharmacy expenses such as GLP-1s being the main driver. Because GLP-1s have demonstrated clinically significant results in many chronic conditions beyond weight loss, I expect to see physicians beginning to prescribe them for additional indications, opening the door for coverage of conditions such as kidney disease, liver disease, heart disease, sleep apnea, and more. 

Given this backdrop, it’s worthwhile for employers to dive into the benefits and costs of these medications — even if you don’t currently offer coverage. Wherever you fall on the coverage spectrum, there are strategies employers can implement to better the health of their people while mitigating costs. 

The challenge of GLP-1 coverage

Even before this expected indication expansion, GLP-1 coverage grew 30% this past year. Today 1 in 3 employers offer GLP-1 drug coverage for both type 2 diabetes and weight loss. The impact of GLP-1s on additional chronic conditions will make coverage even more common and necessary in the future. Right now, with healthcare budgets tightening and healthcare costs growing, many organizations are weighing whether to increase, maintain, or reduce current coverage. And here’s the thing: there’s no universal solution. But there are proven strategies to improve employee health while controlling costs — no matter where you are on the GLP-1 coverage spectrum. 

Begin with behavior change, regardless of GLP-1 coverage

A good behavior-change program serves as a solid foundation for a wellness benefits strategy, amplifying tools including GLP-1s, in the following ways:

1. Sustainability –  The key to lasting results? A quality behavior-change program provides skills that address sleep, physical activity, coping mechanisms, nutrition, eating behaviors, stress levels and more. This leads to sustainable weight loss and increased quality of life, which reduces the risk of chronic disease, while providing tools for better management.
2. Cost mitigation –  By addressing weight-related chronic conditions, a behavior-change program can reduce or delay the need for more expensive options, such as GLP-1s. This will be particularly pertinent when coverage expands to include more common indications, such as sleep apnea.

The importance of personalization

Flexible, individualized wellness plans can meet each employee’s unique needs, regardless of GLP-1 use. Each person has their own lifestyle, schedule, eating behavior, medication use, dietary needs, risk factors, and more — all of which require various levels and types of support. Personalized solutions engage all populations and make it easy for everyone to build skills for lasting behavior change ultimately reducing claims costs. A personalized approach is especially important when it comes to GLP-1s and considerations such as step therapy, side effect management, and medication adherence to ensure everyone receives the right medication at the right time

Filling in care gaps for hard-to-reach populations

The Catch-22 of wellness programs is that the people who need it most can be the most difficult to engage. Numerous elements affect program adherence, including access to care, socioeconomic factors, cultural/language barriers, chronic condition burnout, and mental health. Engaging this population requires a nuanced approach to address these potential barriers. When it comes to GLP-1s, medication adherence is an additional issue with 3 out of 4 patients quitting these drugs before the two-year mark. Incorporating both digital and human touchpoints with inclusive content that’s adaptive to each person’s culture and socioeconomic status will help fill in gaps in care.

Balancing cost and care

No matter where employers fall on the GLP-1 coverage spectrum, the following will help contain costs and maximize clinical effectiveness:

1. Focus on preventive care – The best claim is the one that doesn’t happen. Preventive care rooted in behavior change acts as a safety net that provides skills to improve well-being and decrease the risk of future chronic conditions. 
2. Offer a full-spectrum of weight-loss medications beyond just GLP-1s – There are many more affordable weight-loss medications outside of GLP-1s that have been around for years. It is important to leverage the full range of weight-loss medications, to ensure individuals get the right treatment based on their unique needs. Not using the full-spectrum of weight-loss medications can be both clinically detrimental and unnecessarily costly. 
3. Implement stepped care – There is no one-size-fits-all approach to weight-loss medication, and GLP-1s should not necessarily be the first line of defense. Consider using GLP-1s only when other medication protocols have failed and prescribe the most cost- and clinically effective drug, considering the patient’s whole health.
4. Leverage data and tracking – I love to say “you don’t know what you don’t know,” which is especially important when measuring health outcomes. Make sure you receive regular reporting to adapt to your population’s specific needs. 
5. If integrating GLP-1s, fold into a broader strategy – GLP-1s are one tool within the wellness toolbox — never a standalone solution. Adding GLP-1s to an already robust wellness program addresses the entire spectrum of your population’s health needs, leading to better outcomes and reduced healthcare costs.

Preparing for the future of chronic condition care

Though chronic disease treatment is rapidly expanding, balancing the latest medication with proven initiatives can help employers manage rising healthcare costs wherever you fall on the GLP-1 coverage spectrum. By leading with behavior change and focusing on personalization, engagement initiatives, and strategies to balance cost and care, employers can be better prepared for the rising costs of tomorrow without sacrificing the health of their people.

Photo: Jason Dean, Getty Images

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