GLP-1 medications pose such a great financial burden to employers that they may agree to a single-payer healthcare system run by the Government as a way of addressing the problem.
Ozempic and Mounjaro are the two main GLP-1 medications used to treat Type 2 Diabetes. Wegovy and Zepbound are the two main GLP-1 medications used to treat obesity.
GLP-1 medications account for 9% of an employer’s prescription medication spend on average, yet only 1.7 percent of plan members are on GLP-1 medications.
Twelve percent of US adults have type 2 diabetes and 42 percent of US adults are obese, so if only 1.7 of plan members are on GLP-1s, then their overall prescribing is just barely getting started. GLP-1 medications cost $9,000 to $10,000 per person per year after PBM discounts and rebates. They comprise two of the top four medications by total overall spend by employers.
Strategies to Lower Spending on GLP-1s by Employers Include:
1) Prior Authorization, HOWEVER, if an employer chooses to only cover GLP-1 medications for plan members above a certain BMI, then the pharmaceutical manufacturers will refuse to pay them rebate dollars–thus raising the overall cost of the medications.
2) Step Therapy
3) Non-Coverage Alternatively, GLP-1 medications pose such a great financial burden to employers that they may agree to a single-payer healthcare system run by the Government as a way of addressing the problem.
Additional Homework Reading Assignment:
Blue Cross Blue Shield of Massachusetts Dice “NO MAS!”…………
