Employers are facing significant challenges in managing the rising costs of GLP-1 medications, as demand for these treatments continues to increase. In response, the **Peterson Health Technology Institute** (PHTI), an independent evaluator of digital health solutions, has released a comprehensive guide aimed at assisting employers with GLP-1 coverage decisions. This guide emphasizes the importance of balancing employee needs with budgetary constraints while improving health outcomes.
The PHTI report outlines that employers increasingly turn to virtual solutions to effectively manage GLP-1 coverage. These solutions can be categorized into two main types: comprehensive programs that offer prescriptions for weight loss and wraparound programs that provide lifestyle support while employees obtain prescriptions from other sources. The guide highlights three key phases in which virtual solutions can assist employers in this endeavor.
Key Recommendations for Employers
Drawing from employer experiences, vendor data, and expert interviews, PHTI provides five essential recommendations for businesses looking to establish sustainable GLP-1 coverage.
Firstly, employers are encouraged to set clear, clinically-driven eligibility criteria for coverage. Utilizing virtual programs to implement these criteria allows for prioritization of patients who demonstrate the greatest potential for clinical and economic benefits, particularly those with a higher body mass index.
Secondly, the guide suggests that participation in behavioral, nutritional, or lifestyle change programs should be a requirement for receiving coverage. By mandating participation, employers can enhance health outcomes and identify patients who are committed to long-term weight loss and health improvements.
Another recommendation is for businesses to offer structured support for employees who taper off or discontinue GLP-1 therapy. As many individuals may regain weight after stopping medication, providing ongoing access to non-medication components of a virtual solution becomes vital for sustained health benefits.
Additionally, the report advises employers to analyze existing vendor capabilities before integrating new point solutions. This step can reduce redundancy, simplify navigation for employees, and ensure that GLP-1 management is seamlessly incorporated into broader chronic care offerings.
Finally, businesses are encouraged to enter into outcome-based contracts with vendors. Such contracts align costs with long-term performance and reinforce the criteria for GLP-1 coverage, making the financial aspect more manageable.
Addressing the Challenge
In a statement, **Caroline Pearson**, executive director of PHTI, articulated the dilemma facing employers: “Employers are caught between employee demand for highly effective medications and the financial reality of covering them for potentially large portions of their workforce.” She further noted that the market for GLP-1s is evolving rapidly, outpacing traditional benefits planning cycles. With the emergence of new pricing models, direct-to-consumer options, and innovative virtual solutions, employers need an evidence-based approach to make informed decisions that balance access with sustainability.
As the landscape of healthcare benefits continues to shift, the PHTI guide serves as a valuable resource for employers striving to navigate the complexities of GLP-1 coverage while ensuring the health and well-being of their employees.
