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Although more than one-third of self-funded employers now cover GLP-1 drugs for weight loss, 31% of this group are considering stopping coverage or are unsure about continuing coverage in the next 12 to 24 months.
“The rapid rise in demand for GLP-1 medications -- originally approved for diabetes and now for weight management -- has created a defining moment for employer-sponsored health plans,” according to a new survey from insurer Brown & Brown. “As these drugs gain popularity, thanks in part to their clinical effectiveness, employers are grappling with how to balance access to care, clinical outcomes and financial sustainability.”
Many employers who currently offer coverage have restrictions in place to control access. Most require prior authorization, while few have lifetime maximums or prescriber limitations:
- Prior authorization required, 80%
- Clinical criteria beyond FDA guidelines, 54%
- Coverage limited to specific GLP-1, 43%
- Participation in a lifestyle program, 20%
- Coverage limited to a specific duration or number of refills, 15%
- Step therapy required, 13%
- Prescribing limited to certain specialist types, 13%
- Prescribing limited to one source or sole prescriber, 9%
- Coverage limited to lifetime maximum, 4%
Seventy-one percent of employers surveyed are seeking innovative solutions by actively exploring or considering alternative access arrangements, such as direct-to-consumer programs for their members. The remaining 29% are unlikely to consider or unsure about alternative access arrangements.
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