As demand for GLP-1 medications continues to escalate, employers are grappling with the rising costs associated with providing coverage to their employees. To assist in navigating these challenges, the Peterson Health Technology Institute (PHTI) has released a comprehensive guide aimed at helping employers manage GLP-1 coverage effectively.
The guide highlights that many employers are increasingly turning to virtual solutions as a means to balance their budgets while improving health outcomes for employees requiring GLP-1 medications. These solutions can be categorized into two main types: comprehensive programs that integrate prescriptions for weight loss and wraparound programs that focus on lifestyle support while employees obtain prescriptions from other sources.
Five Recommendations for Sustainable Coverage
Drawing on data from employers, vendor insights, and expert interviews, PHTI outlines five key recommendations for companies looking to implement sustainable GLP-1 coverage strategies.
Firstly, employers should establish clear, clinically-driven eligibility criteria for coverage. Utilizing virtual programs to enforce these criteria ensures that employees with the greatest potential for clinical and economic impact, such as those with a higher body mass index, are prioritized.
Secondly, participation in behavior, nutrition, or lifestyle change programs should be mandated for employees to receive coverage. This requirement can enhance outcomes and identify individuals committed to achieving long-term weight loss.
The third recommendation involves offering structured support for employees who taper off or discontinue GLP-1 therapy. Since discontinuation often leads to weight regain, ongoing access to the non-medication components of a virtual solution is crucial for maintaining progress.
Before introducing additional point solutions, employers are advised to evaluate existing vendor capabilities. This approach minimizes duplication of services, simplifies navigation for employees, and integrates GLP-1 management within broader chronic care offerings.
Finally, businesses are encouraged to engage with vendors through outcome-based contracts. Such agreements align costs with long-term performance and reinforce the established GLP-1 coverage criteria.
Challenges and Opportunities in Healthcare Coverage
Caroline Pearson, executive director of PHTI, emphasized the complex environment 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 stated. The evolving market for GLP-1s is outpacing traditional benefits planning cycles, with new pricing models and direct-to-consumer options emerging rapidly.
This report offers employers an evidence-based framework to make informed decisions that reconcile access to necessary medications with the sustainability of coverage. As the landscape of healthcare continues to change, these insights will be invaluable for businesses aiming to support their employees effectively while managing costs.
In conclusion, the guide from PHTI serves as a vital resource for employers navigating the complexities of GLP-1 medication coverage. By adopting these recommendations, companies can enhance employee health outcomes while maintaining fiscal responsibility.
