Creating a GLP-1 Weight Loss Strategy: A Guide for Employers

by
Nomi Health
Nomi Health
on
June 7, 2024

As an HR or benefits pro, you've probably noticed the explosion of interest in a new class of weight loss drugs known as glucagon-like peptide 1 (GLP-1) receptor agonists. Medications like Ozempic, Wegovy, and Mounjaro, initially used to treat type 2 diabetes and obesity, are now widely discussed by celebrities and on social media for weight loss. With obesity driving over $1.7 trillion annually in economic costs in the U.S., these drugs represent a potential game-changer. But they come with significant financial implications - a new Nomi Health Trends in Spend analysis [LINK] reveals GLP-1s ate up nearly 10% of self-funded employers' total prescription drug costs in 2023 alone.

GLP-1 medications can be incredibly effective for short-term weight loss, which is crucial for improving obesity-related conditions like diabetes and heart disease. However, they come with a substantial price tag—$10,000 or more per patient per year. For self-funded employers, this represents a significant added cost that must be carefully managed.

Over half of commercially insured adults may be eligible for these treatments under U.S. Food and Drug Administration (FDA) guidelines. This raises several important considerations:

Long-term efficacy
While showing great promise initially, questions remain about whether patients can sustain weight loss results over extended periods without regaining, jeopardizing improvements to related health issues.

Product safety
As a broader population explores GLP-1s for weight management, monitoring their long-term safety profile is crucial for ensuring positive health outcomes.

Supply challenges
Persistent product shortages and availability issues create barriers that need proactive management to ensure reliable access.

Off-label usage
Increased public awareness has already led to off-label prescribing for cosmetic weight loss, straining supply, and raising safety and cost concerns.

Cost and accessibility
With costs averaging $936 per prescription, these advanced treatments are often inaccessible without comprehensive coverage, even after discounts and rebates.

Unfortunately, there are no easy answers for employers. Restricting coverage could cause you to alienate employees and lose talent in today’s competitive market, while offering open coverage is financially unsustainable long-term.

A strategic approach

Employers need a comprehensive weight management program that ensures responsible access to GLP-1 medications while controlling costs. Here are five key tactics to consider:

1.    Utilization management through priorauthorization
Implement prior authorization and quantity limits to ensure GLP-1s areprescribed only for FDA-approved uses and appropriate quantities, curbingoff-label utilization. For example, CerpassRx has blocked 21.5% ofinappropriate requests using such controls.

2.    Prescription optimization Maximize the use of coupons, copay cards, and alternative sourcing to reduceprescription costs. CerpassRx’s Prescription Optimization Program achieves anaverage savings of 56% per GLP-1 prescription.

3.    Integration with coaching andnutritional therapy  
Recognize that medication alone isn’t enough for effective weight loss.Integrate coaching and sustainable habit changes into your program. Partnerwith programs that provide nutritional therapy, exercise support, andnon-pharmaceutical interventions. For instance, Virta Health has shown a 63%decrease in diabetes prescription costs within one year.

4.    Clinically appropriate accesscontrols  
Implement step therapy for GLP-1 agonists, requiring patients to try morecost-effective treatments, such as lifestyle changes or oral diabetesmedications, before progressing to GLP-1 agonists. This reserves GLP-1medications for those who truly need them, optimizing clinical outcomes andcosts.

5.    Proven cost-management tactics 
For plans covering GLP-1s as weight loss medications, establish criteria such as a minimum body mass index (BMI) and/or waist circumference. Use prior authorizations aligned with product labeling and require confirmation of at least one comorbidity through documentation. Mandate participation in a diet and/or exercise program to ensure comprehensive treatment.

By adopting these strategies, you can effectively manage the rising demand for GLP-1 medications, ensuring appropriate use while controlling costs and supporting your employees’ health. The exact strategy will depend on your goals, budget, and employee population.

To learn more about partnering with experts at CerpassRx by Nomi Health, visit (Nomi Health or CerpassRx website). We are committed to balancing access and cost, helping you manage drug spend and achieve positive outcomes as new medications emerge.