THOUGHT LEADERSHIP
By Gabrielle Boisvert, Head of Solution Strategy
It’s been more than 10 years since the first GLP-1 received FDA approval for weight loss. Five years later, the approval of Wegovy made GLP-1 an ubiquitous term featured in every conversation about obesity. Since then, employers have grappled with employee demand for covered access to these budget-busting therapies.
For a period of time, employers—particularly large organizations—adopted for GLP-1 coverage for obesity. However, the trend may be shifting. As organizations feel the pressure of rising overall healthcare costs, employers are reconsidering their decision to cover GLP-1 therapies for weight loss.
Working closely with employer groups, we’re seeing unprecedented engagement from the C-suite, and employers are split in their approach to GLP-1 coverage. If there’s one thing everyone can agree on, it’s that a one-size-fits-all approach doesn’t work. GLP-1 strategies vary, and the decision to cover or not cover is just the beginning.
GLP-1s have shone a light on obesity. For the first time, employers are making their obesity benefits strategy a priority because they see the potential long-term impact. They recognize that proactively addressing obesity can help prevent top healthcare cost drivers, such as cancer and diabetes. In short, obesity treatment is about gains in health and not just about loss of weight.
In our conversations with employers, we emphasize the value of healthy behaviors, such as proper nutrition, physical activity, sleep and stress management, whether or not GLP-1s are part of the plan. Providing access to evidence-based interventions that support meaningful, long-term behavior change is critical to the success of GLP-1 management.
Employers see the benefits of GLP-1s—both in terms of health outcomes and what coverage can do to employee satisfaction. In one survey, 75% of employers believe GLP-1 coverage is tied to better employee satisfaction and well-being.
Still, coverage isn’t always financially practical. The benefits of GLP-1 coverage can be overshadowed by higher premiums for all employees or other programs that must be sacrificed to balance the budget.
Not offering coverage doesn’t mean employers can’t help their people with clinically sound weight loss. Direct-to-consumer (DTC) platforms, such as LillyDirect or NovoCare, make FDA-approved GLP-1s accessible and more affordable. They provide an option that can help prevent people from going the route of compounded drugs.
In a recent Teladoc Health survey, we found two in three people who may be eligible for a GLP-1 would be willing to share or cover the cost at a discount as part of a virtual care program. Employers can partner with Teladoc Health to provide the proven behavior change support to pair with DTC platforms. Giving people access to providers trained in obesity medicine, medical nutrition therapy with registered dietitians, expert health coaches and tools to help maximize the effectiveness of GLP-1s while minimizing pharmacy spending is a win-win.
When employers elect to cover GLP-1s, it’s just the first decision. Teladoc Health acknowledges employers have different goals when it comes to GLP-1s—often trying to balance access and cost containment. There are different levers employers can use to achieve this.
Most people get GLP-1s from their primary care physician, and studies show this means they are more likely to discontinue GLP-1s prematurely. For employers, this results in pharmacy spending without better outcomes.
Benefit leaders may have experience implementing narrow network plans that don’t gain traction because employees prefer options. For GLP-1s specifically, a narrow network made up of providers with experience in obesity medicine adds a level of quality and value that benefits both employers and their employees.
First, considering the shortage of obesity specialists, access to experienced providers is hard for patients to find.
People seeking a GLP-1 through Teladoc Health will see a provider with experience in obesity medicine. Care plans are personalized and may include no medication, lower cost anti-obesity medications or GLP-1s based on various factors.
Employers have the option to require their people to go through a Teladoc Health provider for coverage. This helps ensure safe, clinically appropriate prescribing and can set their people up for long-term success under the guidance of a dedicated care team.
Due to the importance of behavior change, participation in a lifestyle program has become a prominent method for employers looking to manage costs and maximize their investment.
Teladoc Health has the capability to exchange member-level data with pharmacy benefit managers to support ongoing GLP-1 coverage. Guardrails can be set up that require a person on a GLP-1 to engage by weighing in regularly, meeting with a health coach and food logging to maintain coverage.
This helps ensure people on a GLP-1 are taking steps to make necessary lifestyle changes. This maximizes the effectiveness of the drug and can establish healthy behaviors that allow them to maintain weight loss if their provider determines it’s clinically appropriate for them to come off a GLP-1.
GLP-1 spending has skyrocketed in recent years. With the potential for new indications, such as the treatment of Alzheimer’s disease, sleep apnea and certain types of cancers, costs may continue to rise.
We understand the challenges employers face. With behavior change as a foundation, Teladoc Health has the capabilities to effectively adapt to employers’ coverage strategy and help them meet the needs of their people without breaking the budget.
