As demand for GLP-1s skyrockets, employers are struggling with the cost to cover these expensive medications for their employees.
That’s why the Peterson Health Technology Institute, an independent evaluator of digital health solutions, recently released a guide for employers on GLP-1 coverage. It states that to help manage their budget and improve outcomes for employees when it comes to GLP-1s, many employers are turning to virtual solutions. There are three phases in which virtual solutions can help employers manage GLP-1 coverage, the guide shows:
- Initiation: Providing limited GLP-1 coverage to support those most likely to benefit. This includes narrow prescriber networks and requiring alternative weight loss programs as step therapy
- Maintenance: Maximizing clinical benefits by improving medication adherence and outcomes, such as through lifestyle changes and managing side effects
- Supported discontinuation: Helping sustain weight loss after stopping GLP-1s, including behavioral support to reduce weight rebound
Virtual solutions largely fall under two main categories: comprehensive programs that include prescriptions for weight loss and wraparound programs that focus on lifestyle support while employees access prescriptions elsewhere.
Drawing on employer experiences, vendor data and expert interviews, PHTI outlined five key recommendations for employers seeking to design sustainable GLP-1 coverage:
1. Employers should set 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 behavior, nutrition or lifestyle change programs to receive coverage. Mandating members to complete lifestyle change programs will help improve outcomes and determine which patients are committed to long-term weight loss.
3. Businesses should provide structured support for those who taper or discontinue GLP-1 therapy. Those who go off the drugs often regain weight, so it’s important to provide ongoing access to “nonmedication components” of a virtual solution.
4. Before adding additional point solutions, employers should analyze existing vendor abilities. This will reduce duplication, simplify employee navigation and integrate GLP-1 management into broader chronic care offerings.
5. Businesses should contract with vendors using outcome-based contracts that align costs with long-term performance and reinforce GLP-1 coverage criteria.
“Employers are caught between employee demand for highly effective medications and the financial reality of covering them for potentially large portions of their workforce,” said Caroline Pearson, executive director of PHTI, in a statement. “The market for GLP-1s is evolving faster than traditional benefits planning cycles, with new pricing models, direct-to-consumer options, and virtual solutions emerging rapidly. This report provides employers with an evidence-based approach to make informed decisions that balance access with sustainability.”
Photo: Jason Dean, Getty Images
