Building a Cost and Care-Conscious GLP-1 Program

The Science and Trends Behind GLP-1s

GLP-1s, or glucagon-like peptide-1s, are a class of medications that have been around for nearly 20 years. They were first discovered in the venom of the Gila monster after scientists grew curious about the reptile’s ability to eat just a few times a year. 

In humans, the GLP-1 hormone is naturally released from the small intestine and colon after eating. The hormone works by attaching to receptors located throughout the body, including in the pancreas, liver, stomach, and brain. GLP-1 medications work by targeting the brain’s appetite regulation centers and slowing down digestion, which promotes a feeling of fullness, or satiety. 

These medications have become a game-changer for the treatment of both diabetes and obesity. The recent surge in public awareness around GLP-1s is largely due to FDA approval for new indications, particularly weight management. This has resulted in the number of American adults taking GLP-1s increasing by 587% over the last five years. The impact of GLP-1s gaining more cultural consciousness is far reaching: a staggering 67% of Americans would even prefer to stay in a job they dislike to maintain access to coverage for these medications.

This high demand has led to a significant increase in costs for employers. Drugs targeting weight management accounted for nearly half of the increase in drug spend in 2024, and the average list price for a GLP-1 is around $1,000 per month. To combat these costs, many employers are implementing strict prior authorizations, but even with these measures, spending continues to skyrocket.

Your employees want, and need, GLP-1s, but how can you deliver on their expectations without breaking the bank? Let’s explore the building blocks for sustainable weight management program success.

The Right Strategy: Beyond a Prescription

The conversation around weight management should not begin and end with a prescription. A truly effective program focuses on a holistic, long-term approach. GLP-1s are not a magic bullet, but rather one part of a comprehensive strategy that includes:

• Holistic Lifestyle Modifications:

• Medication Optimization and De-escalation:

• Effective Care Escalations: 

The Right Partners: Asking Crucial Questions

To build a sustainable weight management program, it’s crucial to partner with vendors who are transparent and aligned with your goals. Getting the right partners on board starts with asking the right questions of any potential or current pharmacy benefit managers and care support partners. Here are some questions to start crucial conversations with your vendors:

Questions to Ask Your PBM: 

It’s crucial that your pharmacy benefit manager (PBM) partner is transparent with their GLP-1 procedures and provides executional tools for cost control. Be sure to dig into what their net cost for covered GLP-1s are and how they pass along savings from manufacturer rebates and copay cards to you and your members.

It’s also important to understand their criteria for appropriate use, including clinical criteria beyond just BMI, and the percentage of eligible patients who get approved for a GLP-1 prescription. Additionally, make sure they offer alternative weight management medications/ solutions and can guide members who don’t qualify for a GLP-1 toward other options. 

Questions to Ask a Care Support Partner:

You need to select a care support partner that can help bolster a comprehensive care program that prioritizes a holistic, long-term approach to health. Ask a potential care support partner how they support lifestyle changes using methods like motivational interviewing, trauma-informed care, and sports nutrition. Their approach should also promote a “health at every weight" philosophy and support long-term success through coaching.

You’ll want to ensure their programs align with your PBM’s formulary, and that they have a process for finding lower-cost alternatives and supporting medication de-escalation. Finally, ask how they provide a seamless member experience, including virtual counseling for side-effect management and coordination with surgical and behavioral health specialists.

By getting answers to these questions, you can ensure your program is built on a foundation of clinical appropriateness, cost-effectiveness, and robust member support. This strategic approach will not only help prevent runaway costs but also deliver a truly exceptional health experience for your members.

To dive deeper into how to build a sustainable, cost-effective weight management program, watch our complete webinar, The GLP-1 Breakthrough: What it is, Why it Matters, and How to Drive Health Plan Savings, or download the The ABCs of GLP-1s for Self-Funded Plans guide.