Few healthcare issues have generated as much interest among employees and employers as GLP-1s.
There is good reason for that. For some, these drugs can produce significant improvements in their health. For a person with diabetes, we may see an improvement in A1C, and for those struggling with their weight, some may see significant results when taking GLP-1s, while others are nonresponsive and may lose very little or no weight at all. The key factor we need to keep in mind is that everyone is unique and people’s bodies respond differently to medication. That difference matters to the patient, and it should also matter to the employer paying for their healthcare.
Much of the discussion about GLP-1 benefits has presented employers with two choices: cover the drugs broadly or stop covering them. But there is a better approach.
Employers need to know what happens after the prescription
Employers have a difficult job. As healthcare costs are predicted to rise in 2027, they are facing pressure to find savings. They want employees who can benefit from these treatments to have access to them, but with high costs, they are starting to drop GLP-1 coverage, and asking employees to pick up more of the expense.
Paying for every prescription without understanding what happens after treatment begins creates another problem. If an employee takes a GLP-1, loses weight and keeps it off, that matters. If someone with diabetes sees their A1C improve, that matters too. Likewise, when another employee takes the drug and sees little or no benefit, employers need to understand that as well.
Better information can help preserve access
The Health Transformation Alliance’s 80 plus member companies pool their aggregate de-identified claims data from over 5 million Americans; we then add clinical information from electronic health records to empower employers to make more informed decisions about who is likely to benefit and what may need to happen before treatment begins. That information can also help employers make clinically-driven coverage decisions rather than responding to a growing pharmacy bill with broad benefit cuts.
Taken together, claims data and Electronic Health Records (EHRs) can tell us both the costs and outcomes, painting a better picture of results.
Employers are therefore better positioned to manage the growing cost of GLP-1s without automatically raising deductibles, increasing employee contributions or reducing coverage. When costs rise, asking workers to pay more may reduce the employer’s immediate bill, but it does nothing to address money being spent on treatments that provide little benefit. Better information gives employers an opportunity to tackle the spending itself while protecting access for employees who are likely to benefit.
The purpose is to help people get care that is likely to improve their health while making sure healthcare dollars are being spent effectively.
Put the employee at the center of the decision
More precise coverage brings more responsibility with it. Coverage criteria need to be grounded in credible clinical information and what we know about the patient’s likely response to the drug.
Communication matters, too. No employee wants to hear that a benefit is being taken away from them, particularly when it involves their health. But that conversation is very different when there is credible clinical information showing that a particular treatment is unlikely to benefit them. Employers need to be able to explain why a coverage decision was made, what information was considered, and what other treatment options remain available.
Done well, this can help employees understand that the decision is grounded on their individual health and the likelihood that a treatment will work for them. That creates a much better conversation than simply telling someone their employer can no longer afford to cover the drug.
GLP-1s give employers an opportunity to think differently about how they approach expensive treatments. Success should be measured by whether people are getting healthier, rather than how many prescriptions a health plan pays for.
