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Expect More From... the GLP-1 Quandary!

Writer's picture: Christine JohnstonChristine Johnston

Move over childcare reimbursement/assistance, unlimited PTO or even WFH/hybrid benefit requests! Startling results from a recent 9amHealth survey identify coverage for a weight loss and diabetes drug class, GLP-1, are ringing in the new year as one of the most sought-after employee benefits.  As promised in our recent post, Navigating Complex Benefit Trends, let’s dive deeper into the GLP-1 topic everyone must answer to in 2024.


Starting with the numbers, here were a few statistics that jumped off the page from Americans who responded in December 2023 to the 9amHealth survey. ​


Specific to their choice of jobs:

  • 67% would stay at a job they don't like as opposed to starting a new job to keep insurance coverage for weight loss medications​.

  • 20% of those who are employed by an organization that does not offer coverage for GLP-1 medications said they would be "likely" or "very likely" to change jobs to gain coverage​.

Specific to their personal actions:

  • 50% of respondents are cutting back on spending in major categories such as entertainment, groceries, luxury, restaurants (dining) and general retail purchases to afford these medications.

  • 39% are cutting back on savings and investments to afford these medications.

  • 38% admitted to trying these products through non-FDA approved pathways (compounding and counterfeit) which significantly increases the likelihood of complications.

 

These data points are just the tip of the iceberg for what is to come. With additional drug classes receiving diabetes and obesity approval, the existing GLP-1 class is widening their FDA indications looking to overtake common heart disease, kidney, and substance abuse therapies to name a few. Updated or new guidelines are expanding the eligible population.  Employers can no longer say we don’t cover weight loss drugs to stop the GLP-1 conversation (or spend!). We have the privilege and responsibility to help provide solutions for this highly debatable topic before benefits are truly unaffordable.  

 

2024 kicked off the year with weaker clinical controls and stronger financial traps from the Big 3 PBMs, incentivizing an increased volume of dispensing for these drugs. In light of this position and more than 80% of the market utilizing one of these PBMs, the responsibility falls directly to the employer for decisive coverage rules. Due to the safety concerns and high costs, both short- and long-term, coverage must be thoughtful across employee benefit, including wellness offerings. In the article, 2024 Employer Sponsored Health Plan Predictions: GLP-1s, Vendors, Data, Hodgeson makes a case for the need to consider these drugs in similar fashion to Xanax and opioids. If we don’t take this seriously from the start, we will spend decades reversing the unintentional consequences. I think we can agree that there is a clinical need for anxiety and pain therapy, but when left to weak criteria, the damages at a personal and societal level are staggering.

 

Despite the number of plans expecting to cover these drugs for weight loss is likely to double this year, Employers Covering GLP-1 Drugs in Health Plans Could Nearly Double in 2024, we applaud the Mayo Clinic for hitting the pause button Mayo Clinic moves to limit weight loss drug coverage for employees. Mayo Clinic has received heavy criticism for its newly imposed $20k lifetime benefit for this type of care. Easily forgotten is that the thresholds can always be increased or even removed as more data supporting long-term use becomes available. In the meantime, Mayo Clinic is encouraging close relationships and consistent conversation between the patient and their provider, encompassing all facets within this health journey. Mayo Clinic is also not hindering uncontrolled diabetics in need of this class as this new policy does not apply to diabetes management.

 

If this resonates with you or you feel an obligation for each of us to do our part in promoting safe and fair use, don’t despair if you hear “no” or “not possible” or “not cost effective” to your concerns. We’re here to tell you there is a way. Thankfully there are some mid-market PBMs eager to work with employers to step up and set appropriate clinical and financial guardrails. For those not with such flexible partners, third-party solutions can ride alongside the standard benefit offering to administer your desired benefit design. The consultants at Foundational Pharmacy Strategies have evaluated many of the third-party solutions. If you need inspiration to act, here are 4 good reminders Four Reasons Any Action Is Better than None. Don’t look back and regret not doing more.

 

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