How employers can tackle rising GLP-1 costs: A Q&A with Kristin Hall

As consumer demand for GLP-1’s, such as Ozempic, continues to surge, many employers are left paying the price. In fact, the State Health Plan of North Carolina is set to deny thousands of members GLP-1’s this year after pre-rebate costs soared from a projected $3 million to a staggering $14 million per month.

So how can employers approach GLP-1’s in a way that supports employee health while being financially sustainable? Kristin Hall, VP of Clinical Programs and Patient Experience at apree health, shared her thoughts.

Does the growing demand for GLP-1s call for employers to reevaluate and redesign their benefit strategies?

While GLP-1 weight loss drugs have recently emerged as an effective way of helping address obesity, last year pharmacy benefit costs saw an 8.4% increase year over year. To share one example, usage of GLP-1s among the State of North Carolina Health Plan has escalated by 731% since mid-2023, with projected net costs expected to rise to $170 million in 2024. The extreme financial costs of covering these drugs are serving as a forcing function for employers and benefits managers to rethink how they design benefit strategies for obesity care in a way that is more financially sustainable.

How can employers design coverage for GLP-1 medications in a manner that is financially sustainable yet ensures equitable access for those in need?

Employers can create comprehensive programs where they connect employees to providers or health coaches who can establish health goals, talk through what lifestyle or behavioral changes are needed to reach those goals, and address any pre-existing health conditions that should be taken into account. Because of the skyrocketing costs of GLP-1 medications, some employers are put in a position where they need to make tough decisions about which employees qualify for GLP-1 prescriptions and coverage. It can be beneficial for employers to think about what other specialized medication management and lifestyle weight loss programs they can offer to help address obesity care and offer a multi-pronged approach.

Do you think employers need to focus more on primary care or specialist care in order to combat rising health costs as it pertains to weight loss?

When patients are able to establish a relationship with a primary care provider (PCP), they can take a more proactive approach to their health care and providers can gain understanding of a patient’s health needs, including their medical history, predispositions to certain health conditions, and how their lifestyle or socioeconomic background impacts their health. Patients involved in primary care also indicate a higher likelihood of adhering to their medication. Additionally, they likely are not obtaining prescriptions from multiple sources, indicating appropriate prescribing practices. This underscores the importance of patient engagement in coaching, which leads to better involvement in primary care and timely access to appropriate care.

Furthermore, coaches play a crucial role in facilitating behavior change, helping patients establish routines and habits around medication adherence. All of these factors can play a role in managing weight loss and related health conditions. In addition, it’s important that PCPs play a role in every step of a weight loss management program so that they can monitor for any related effects weight loss can have on a patient’s overall health. For example, if a patient loses weight, a PCP may want to make changes to any blood pressure medication they may have previously been on.

Related: $1,000-a-month Ozempic, new weight loss drug, costs $5 to manufacture: Yale study

How should data and risk assessments be used to help manage employee GLP programs?

Clinical data and health risk assessments can be useful tools for identifying employees who may have been denied a GLP-1 prescription but might otherwise benefit from a weight loss management program. Using clinical data pulled from an employee’s health profile can help inform what other chronic conditions they may be at risk of developing, and how to best chart a path forward that addresses those needs and any other lifestyle or cultural factors that should be taken into account. For example, some members may benefit more from being placed on a medication management plan, while others may be better suited for a lifestyle management path that focuses more on nutrition, behavior change and exercise.

Why is it important for employers to factor in a person’s Social Determinants of Health when determining benefit strategies, particularly around weight loss?

Like many health conditions, obesity can’t be managed with one standard, universal approach. It’s critically important that employers approach and address varying socioeconomic factors for workforce health. Factors like geography, culture, food insecurity, access and education can all have an impact on a person’s health outcomes. We know that certain populations are more heavily impacted and their social determinants of health barriers make it harder to address the larger issues. Employers need to design benefit strategies that are inclusive, supportive, and tailored to a person’s health profile in order to be effective.