In recent years, GLP-1 drugs, such as Ozempic and Wegovy, have gained significant attention in the field of pharmacy, particularly for their effectiveness in either managing type 2 diabetes, severe heart disease, or promoting weight loss. As businesses strive to enhance their employee benefits packages, the inclusion of these drugs has become a topic of interest.
When considering the inclusion of GLP-1 weight loss drugs in their formulary, employers must get an independent assessment of the proper authorization process. Implementing a robust authorization assessment can ensure drugs are prescribed to the appropriate individuals, optimizing their effectiveness and cost-efficiency.
GLP-1 drugs offer notable benefits, including improved glycemic control, weight loss, and potential cost savings associated with long-term health improvements. However, they have potential drawbacks, especially the increase in health benefit costs. A Mercer study showed prescription drug costs rose 8.6% in 2023 which was driven by an increase in GLP-1 drug use. According to a SHRM study, GLP-1 drugs have been found to typically cost a patient $1,000-1,500 per month before employer coverage.
To ensure a successful integration of GLP-1 drugs into benefits offerings, employers should consider the following best practices:
Conduct a thorough cost-benefit analysis: Evaluate the potential impact of obesity medications including GLP-1 drugs in their formulary by assessing the cost per patient, per year and comparing it to the expected health benefits and long-term cost savings including average turnover/tenure.
Collaborate with pharmacy benefit managers (PBMs): Work closely with PBMs to establish appropriate authorization and reauthorization processes to ensure the drugs are prescribed to eligible individuals. A diabetic diagnosis and an A1C lab value is best practice.
Educate employees: Provide employees comprehensive education and resources about the benefits and potential side effects of GLP-1 drugs which can help them make informed decisions about their healthcare.
Future landscape: GLP-1 class will continue to grow as new products enter the market and gain supplemental indications. Certain studies have shown that a GLP-1 drug can slow one’s cognitive decline by protecting the brain, which was reported by the Alzheimer’s Association. The study shows these drugs may protect the brains of people with mild Alzheimer’s by as much as 18% after one year of treatment. In addition to Alzheimer’s, diabetic retinopathy, liver disease, chronic kidney disease and sleep apnea are also going through clinical trials and spend will continue to increase. It is uncertain if manufacturers will include these within the diabetic or weight loss medication class, or potentially develop a newly branded product.
Monitor outcomes: Track the outcomes and effectiveness of GLP-1 drugs within an employee population to assess their impact on health outcomes and cost savings.
By conducting thorough assessments, collaborating with PBMs, and prioritizing employee education, employers can navigate the complexities of integrating GLP-1 drugs into their formulary successfully. With careful consideration and strategic implementation, businesses can provide valuable healthcare options to their employees while optimizing health outcomes and cost savings.
