The new weight loss drugs known as glucagon-like peptide-1 agonists, or GLP-1s, are sweeping the country. Even though there is mounting evidence that GLP-1s don’t work for everyone, the demand is skyrocketing. This puts extraordinary pressure on health plans and employees due to their expensive price tag – in the range of $1,000 a month. Partly as a result of these treatments, healthcare costs are predicted to surge 7.8% next year.
But there is a solution to help mitigate the costs – a third-party vendor, such as InformedDNA. Our genetic counselors can implement a genetic risk stratification test that can help point each individual to the weight-loss intervention that is most likely to be effective for them, both reducing costs and increasing the odds of successful weight loss.
The GLP-1 Explosion
The explosion of interest in GLP-1s such as Novo Nordisk’s Wegovy and Saxenda, their
exorbitant costs, and the number of people who meet FDA guidelines to take them is unmatched.
Getting the right patient connected to the right treatment is the core challenge. There’s no room for trial and error. Many other medications work just as well to help some people lose weight as more expensive GLP-1s.
More employers who cover GLP-1s are partnering with vendors to set standards beyond Food and Drug Administration requirements, alter benefit designs, limit prescriber networks, and manage lifestyle programs.
In May 2024, KFF found 6% of U.S. adults were using a GLP-1, and estimated that 49.3 million people, amounting to 42% of those with employer-sponsored insurance, may be eligible for the medications based on FDA indications.
Two-thirds of large employers cover GLP-1s for obesity and more are considering it over the
next few years, according to a Business Group on Health survey. At the same time, the health plan for North Carolina state employees dropped GLP-1 coverage for weight loss in April, and Blue Cross/Blue Shield of Michigan is cutting GLP-1 coverage for fully insured large group plans in 2025. Employers are learning from one another about the most effective approaches and finding they can’t do this alone.
The Utilization Management Solution: Third-Party Vendors
That’s why they are partnering with vendors, which typically charge per-member, per-month fees, to oversee utilization management, limit GLP-1 prescribers to physicians trained to treat obesity, help employees manage side effects, promote fitness and nutrition, and potentially transition off the drugs over time.
Employers offering access to GLP-1s for weight loss are playing the long game. It remains to be
seen whether these blockbuster medications and related partnerships will produce cost savings
over time by making workers healthier.
Employers are hoping additional oversight and education will ensure the right people get access
and adhere to the medication regimen. They’re also looking for reduced spending in other areas, such as fewer complications from diabetes or cardiovascular disease, to balance the new costs and generate a return on investment.
Again, GLP-1s aren’t for everyone. A third-party vendor such as InformedDNA can help payors connect patients to the most effective weight-loss medication, leading to great efficiency and reduced costs.
