GLP-1 Drugs: Essential insights for employers
What are GLP-1 drugs?
Originally designed to help manage type 2 diabetes by regulating blood sugar levels, these medications are now frequently prescribed for weight loss as well. However, this increase in demand has had a notable impact on overall pharmacy spending, making it essential for employers to pay attention to how these drugs affect their health care costs.
Why should employers care?
One major concern is the skyrocketing price of GLP-1 medications. Pharmaceutical companies are charging Americans 10 times what they do in other countries such as Britian, Australia and France. When families and employers make a significant investment, we want the results to be successful.
The rising appeal of GLP-1 drugs for cosmetic weight loss has led to a significant increase in off-label prescribing, which can result in the potential for unnecessary claims, legal or ethical dilemmas and the risk of poor health outcomes for individuals who may not receive the right support for their condition.
How Univera Healthcare helps employers manage this trend
As the GLP-1 landscape evolves, we are dedicated to keeping our policies aligned with the latest data to ensure the best outcomes for your team.
On January 1, 2025, Univera Healthcare made important updates to our prior authorization criteria to align them with bariatric surgery standards. BMI requirements were increased to greater than 40 mg/kg2 or greater than 35 mg/kg2 with one more weight-related comorbidity. We did this to focus our resources on members facing the highest risks of serious medical issues and life-threatening complications. This decision came after thorough analysis and reflection of our commitment to prioritizing the health and safety of our groups and their members.
To combat inappropriate prescriptions and further ensure the safety of employees, we employ utilization management programs. The prior authorization process requires health care providers to certify that a member is enrolled in an approved weight loss program and meets the necessary medical criteria for GLP-1 therapy. This careful approach aims to maintain access to requisite treatments while effectively managing costs.
Through this management of GLP-1 use, Univera Healthcare has realized cost savings, as indicated by the graph below:
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'Univera Healthcare is using what appears to be the most sensible weight loss GLP-1 prior authorization criteria in the marketplace, without significantly disrupting rebates.' — USI Partner
What we know about the future of GLP-1 drugs
In 2024, there were significant advancements with GLP-1 indications. Zepbound® received an expanded indication for the treatment of sleep apnea, enhancing its role in patient care. Wegovy® also expanded its indications by gaining approval for reducing the risk of major adverse cardiovascular events.
Additionally, as of January 2025, Ozempic® is now approved for use in patients with type 2 diabetes who also have chronic kidney disease. These developments represent important progress in the management of various health conditions under one drug.
Given the market success of these products, there has been significant interest and investment in obesity medications. Many manufacturers are now exploring new approaches, including new drugs, alternative delivery methods, and improved side effect profiles. More than 15 new obesity medications are expected to gain approval over the next five years.
Partner with Univera Healthcare
While GLP-1 drugs possess the potential to enhance employee health, they must be utilized responsibly. By partnering with a pharmacy benefits provider such as Univera Healthcare, employers can better control costs, protect their bottom line and ensure their workforce receives the appropriate care.
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