Exploring the most effective ways to integrate GLP-1s into your benefits plan

Understanding GLP-1s

GLP-1s, such as Ozempic and Wegovy, have gained prominence for their effectiveness in treating Type 2 diabetes and facilitating significant weight loss. Beyond these applications, ongoing research is exploring their potential to address conditions like rare metabolic disorders, cardiovascular diseases and even substance use disorders. This expanding scope underscores the importance for employers to stay informed about the evolving clinical benefits of these medications.

Employer coverage trends: GLP-1s for weight loss

Despite the clinical advantages, employer adoption of GLP-1 coverage remains limited for weight loss. Many employers are hesitant to include these medications in their health plans due to concerns about long-term efficacy, their ability to reduce related medical costs and the substantial costs associated with these treatments. This cautious approach reflects the need for a thorough evaluation of both the health benefits and financial implications.

When incorporating GLP-1s into health plans, the most effective strategy involves a comprehensive approach that ensures every member receives the right level of care at the right time. 

• Integrate with lifestyle modification programs: Combining GLP-1 usage with behavioral and nutritional support leads to more sustainable weight loss. This integrated approach addresses the root causes of obesity and promotes better long-term health outcomes.
• Conduct financial analyses: Employers should meticulously review PBM contracts to identify potential cost-saving opportunities and mitigate financial risks. Understanding the financial landscape is crucial for making informed decisions about coverage.
• Align with organizational culture: Decisions regarding GLP-1 coverage should reflect the company's commitment to employee health, aligning with its cultural values and long-term health objectives. This alignment ensures that health benefits resonate with the workforce and support overall organizational goals.

Risk mitigation and long-term planning

One of the most important aspects of this approach is coupling GLP-1 treatment with lifestyle and behavioral interventions. Relying solely on medication without addressing underlying habits may lead to rebound weight gain and diminished long-term effectiveness. Educating employees about the benefits and potential risks — while also providing robust support systems — is essential for sustained health improvements.

Addressing employer challenges

The rising demand for GLP-1 coverage presents challenges, including employee retention concerns and the proliferation of non-FDA-approved compounded versions of these medications. Employers must navigate these complexities by staying informed about regulatory developments and ensuring that their health plans provide safe, effective and affordable options.

The role of independent healthcare navigation

Independent healthcare navigation provides solutions to help manage the complexities associated with high-cost medications, including GLP-1s. These solutions assist employers in controlling pharmacy costs while ensuring that their members receive clinically appropriate care. By utilizing clinical expertise and proactive member engagement, the right navigation solution can guide employees toward cost-effective, clinically equivalent alternatives — supporting both health outcomes and financial objectives.

Author: Janice Rosenthal, clinical consultant at Marsh McLennan, is a seasoned healthcare consultant and registered nurse. She offers a comprehensive perspective on managing the integration of GLP-1s into employer-sponsored health plans. Her approach emphasizes balancing clinical efficacy with financial sustainability, ensuring that both employee health outcomes and employer cost structures are optimized.