As GLP-1 medications for weight loss continue exploding in popularity, plan sponsors will need to make important decisions about how to offer these treatments in a cost-effective and sustainable way. Whether it’s evaluating coverage strategies or helping members understand all their options, this guide outlines critical insights into the GLP-1 market and actionable next steps for benefits managers.
Understanding GLP-1s for Weight Loss GLP-1 (Glucagon-like peptide-1) receptor agonists help with weight loss by slowing gut function and signaling the brain to reduce hunger.
FDA-Approved GLP-1s The FDA has approved certain GLP-1s for weight loss use and others specifically for treatment of diabetes:
For Weight Loss | For Diabetes |
Saxenda (liraglutide) – Once daily injection | Victoza (liraglutide) – Once daily injection |
Rybelsus (semaglutide) – Once daily tablet | |
Zepbound (tirzepatide) – Once weekly injection | Mounjaro (tirzepatide) – Once weekly injection |
Wegovy (semaglutide) – Once weekly injection | Ozempic (semaglutide) – Once weekly injection |
Key Considerations for Plan Sponsors
Alternative non-GLP-1 options: Scripta’s Med Mapper® identifies highly effective non-GLP-1 weight loss medications that may offer lower-cost alternatives, have different side effects, and are easier to find.
Member challenges with GLP-1s: Many members transition off these GLP-1 weight loss drugs due to high costs, availability issues, or side effects.
Injection considerations: These drugs require self-injection, with varying frequency (daily vs. weekly), which may impact member adherence and satisfaction.
Insurance coverage strategy: Employers and benefits managers should evaluate GLP-1 coverage within their pharmacy benefit plans to ensure cost-effective, high-quality options for members.
Ways to Shop for GLP-1s
There are many ways members can purchase GLP-1 medications, whether they’re using insurance or paying out-of-pocket, and ranging from less regulated options to FDA-approved sources.
Purchasing Outside of the Plan
Here’s how members can get their hands on GLP-1s without using their health plan, from the least to most regulated:
Medical Spas (also known as Med Spas)
Given directly by a med spa provider
Less regulated, making it harder to assess quality and safety
Members should ask about the manufacturing source and verify all active/inactive ingredients
Compounding Pharmacies
Requires a prescription or tele-health provider approval
There are two types that differ in regulatory oversight and manufacturing standards:
503A: Traditional compounding pharmacies that prepare meds for an individual patient
503B: FDA-regulated outsourcing facilities that produce large batches of meds for office use or healthcare facilities
Example: HIMS offers options starting at $165/month
Direct Manufacturer Purchase
Requires a provider’s prescription
Example: Through Lilly-Direct, Zepbound costs as little as $25/month (with commercial insurance) or $399/month (without commercial insurance)
Cash Price + Manufacturer Coupon
Requires a prescription
Available at any pharmacy
Prices vary based on drug, location and availability
Purchasing Using Insurance
Obtain a prescription for an FDA-approved weight loss GLP-1 (Saxenda, Zepbound, or Wegovy).
Explore lower-cost alternatives through different pharmacies or programs.
Use manufacturer assistance programs to reduce out-of-pocket expenses.
Plan Sponsor Strategies: To optimize costs and ensure sustainable access, employers can evaluate tiered pricing models, prior authorization policies, step therapy programs, buying direct, as well as compounding options.
Choosing the Best Option
What should employees consider to make informed decisions when shopping for these medications?
Regulatory oversight: FDA-regulated options (503B compounding, direct manufacturer purchases, and brand-name drugs) ensure the highest safety and quality.
Cost-effectiveness: Compare out-of-pocket costs vs. coverage within the pharmacy benefit plan.
Injection frequency: Some members may prefer weekly injections over daily regimens for convenience.
Alternative solutions: Weight loss programs or lower-cost medications could be effective alternatives.
Curated List of Recommended Providers
We’ve compiled a list of recommendations so members can explore different purchasing options:
Online Pharmacies – Cost-effective options with transparent pricing.
Direct from Manufacturer – Brand-name medications at discounted prices.
Med Spas – Available without insurance but with varying regulation.
Behavioral Health Options – Lifestyle programs such as Noom and WW (Weight Watchers) that may complement medication use.
Final Thoughts
Plan sponsors play a critical role in helping members navigate the cost and availability of GLP-1 medications. Whether it’s by optimizing benefit design, educating members on cost-effective options, or exploring alternative solutions, staying proactive ensures these popular treatments remain accessible and affordable in the long run.
Key Tips for Plan Sponsors:
Evaluate GLP-1 coverage for weight loss in your benefit plan.
Educate employees on safe and cost-effective purchasing options.
Consider alternative weight loss treatments for a more holistic approach.
Have questions? Drop them in the comments or reach out for personalized guidance.
留言