2024 HLTH Recap: GLP-1s Going Under-Covered Panel

The rise of GLP-1 medications for weight loss has sparked a complex debate in the healthcare industry, particularly among employers grappling with coverage decisions. Last month at the HLTH Conference, Lark’s CEO and Co-founder, Julia Hu, joined a panel discussion titled, GLP-1s Going Under-Covered, that talked about the multifaceted challenges and potential solutions surrounding these medications. Here are a few key takeaways from her panel.

Current Market Trends: A Mixed Bag

According to Scott Honkin, Chief Commercial Officer at Weight Watchers, approximately 35-40% of employers are currently covering GLP-1s, with approaches ranging from full coverage to complete exclusion. This variability reflects the ongoing struggle to balance access with cost management.

Whereas Patrice Johnson, Director of Wellbeing Benefits at MGM Resorts International, shared a cautionary tale— revealing that their company experienced a 10-15% increase in pharmacy spend after covering GLP-1s for weight loss in 2023. This substantial rise led MGM to pause coverage for 2025, highlighting the sustainability concerns many employers face.

Addressing Equity Concerns

Equity issues in healthcare remain a critical consideration, especially when it comes to access to medications like GLP-1s. Dr. Shantanu Nundi, President and Chief Health Officer at Accolade, highlighted that individuals with language barriers experience a 25% lower fill rate for GLP-1 prescriptions. This disparity points to the need for healthcare systems to implement more inclusive practices that ensure equitable access for all patients, regardless of their background.

Innovative Approaches

The panel explored several strategies to optimize GLP-1 use and manage costs:

Combination Therapies

Honkin reported that combining their programs with GLP-1 medications resulted in incremental weight loss, while Hu stressed the need for holistic programs that address all aspects of the weight management journey, including lifestyle management, weight maintenance to sustain lifestyle and GLP-1 medication success and GLP-1 companion programs for those on the medications.

AI-Driven Solutions as Cost-Effective Options

As the only hybrid AI/human health coaching company on the panel, Hu brought a tech-savvy perspective to the discussion by highlighting the role of artificial intelligence in cost containment and patient support. By leveraging AI, Lark aims to enhance patient engagement, streamline prior authorization processes and optimize resource allocation, ultimately supporting healthier outcomes at lower costs.

Personalized Care Models

Dr. Nundi emphasized the importance of tailored care delivery and robust primary care in determining appropriate GLP-1 use.

Nuanced Coverage

Suggestions from the panel as a whole included implementing coverage based on BMI ranges and exploring creative rebate structures.

Drug Holidays

Where the industry continues to be polarized towards a GLP-1s-for-all-or-none approach, Lark introduced the concept of periodic breaks from GLP-1 use as a potential long-term management strategy.

Challenges and Considerations

The discussion also highlighted several obstacles:

PBM Rebates

The panel noted that pharmacy benefit manager rebates can significantly limit employers' flexibility in modifying coverage criteria.

Compounded GLP-1s

While explored as a cost-containment strategy, most panelists expressed an all-around caution towards compounded medicines due to FDA approval and safety concerns. Additionally, Lark made the point that cheaper drugs aren’t as sustainable as cost-saving program designs aimed at de-prescription and weight maintenance programs.  

Long-Term Management

The need for more research and evidence to understand the effects of the medications long-term remains a critical consideration in determining sustainable approaches to GLP-1 coverage and use.

Looking Ahead: A Call for Innovation

The GLP-1s Going Under-Covered panel provided valuable insights into the intricate challenges surrounding GLP-1 coverage and the need for innovative solutions. As stakeholders across the healthcare ecosystem navigate these complexities, the emphasis on personalized care, equitable access, and cost-effective strategies will be crucial in ensuring that patients benefit from these potentially life-changing medications. Fostering collaboration among employers, healthcare providers, and technology solutions, is the beginning of a future where GLP-1s are not just accessible, but effectively utilized for the betterment of public health.

Learn more about Lark’s weight management solutions.