Employers are increasingly challenged by the rising costs associated with GLP-1 medications, which have gained popularity for weight management. In response to this issue, the Peterson Health Technology Institute (PHTI) has released a comprehensive guide aimed at helping employers manage coverage for these expensive treatments. The guide emphasizes the potential of virtual solutions to assist employers in balancing costs while enhancing health outcomes for their employees.
According to the PHTI report, the demand for GLP-1 medications has surged, prompting many employers to explore innovative coverage strategies. The guide outlines three phases where virtual solutions can support the management of GLP-1 coverage. These solutions primarily fall into two categories: comprehensive programs that include prescriptions for weight loss and wraparound programs that provide lifestyle support while employees access medications elsewhere.
The report draws on insights from employer experiences, vendor data, and expert interviews, presenting five key recommendations for companies looking to establish sustainable GLP-1 coverage.
Recommendations for Effective GLP-1 Management
Firstly, employers are encouraged to establish clear, clinically-driven eligibility criteria for GLP-1 coverage. Utilizing virtual programs to implement these criteria enables employers to prioritize patients who present the greatest potential for clinical and economic impact. For example, individuals with higher body mass indices may benefit most from these medications.
Secondly, participation in behavior, nutrition, or lifestyle change programs should be a requirement for employees seeking coverage. By mandating engagement in lifestyle change programs, employers can enhance health outcomes and identify patients committed to achieving long-term weight loss.
Structured support is also essential for employees who taper or discontinue GLP-1 therapy. Many individuals who stop taking these medications often experience weight regain, making it crucial to provide ongoing access to non-medication components of virtual solutions.
Before adding new point solutions, employers should evaluate the capabilities of their existing vendors. This analysis can help eliminate redundancies, simplify employee navigation, and integrate GLP-1 management into broader chronic care offerings.
Finally, contracting with vendors through outcome-based agreements can align costs with long-term performance, reinforcing GLP-1 coverage criteria while ensuring financial sustainability.
Caroline Pearson, executive director of PHTI, highlighted the challenging landscape employers face: “Employers are caught between employee demand for highly effective medications and the financial reality of covering them for potentially large portions of their workforce.” She noted that the market for GLP-1 medications is evolving more swiftly than traditional benefits planning cycles, with emerging pricing models, direct-to-consumer options, and virtual solutions complicating the scenario.
The PHTI guide aims to provide employers with an evidence-based approach to navigate these complexities, facilitating informed decision-making that balances employee access to GLP-1 medications with the sustainability of coverage. As the demand for these medications continues to rise, implementing effective management strategies will be vital for employers committed to supporting their workforce’s health and well-being.
