Trending into 2025: Compounding, Cost Containment and Classic Weight Loss Best-Practices

While the promise of weight loss drugs is well established in popular culture, the fact is, benefit coverage for the medications is still relatively low. Only 35-40% of employers are currently covering GLP-1s, with approaches ranging from full coverage to with approaches ranging from multiple layers of restrictions to full coverage¹. This diverse coverage spectrum reflects the complex considerations employers face when deciding on GLP-1 benefits. As we look ahead to 2025, several key trends are emerging that will shape the future of GLP-1 coverage for employees.

‍Emerging Trend #1: Good ol’ behavior change/lifestyle management programs will forever remain timeless

How did people ever manage chronic conditions or lose weight before GLP-1s? Oh, that’s right! They made changes to their nutrition, improved their exercise habits, focused on getting more sleep, and maybe, just maybe, they even quit smoking! What a novel idea! And guess what… these methods all still work! 

While original GLP-1 studies showed that “nonresponsders”, the 10-15% of GLP-1 participants who lost less than 5% of their body weight on the medications, now account for ~20% of all GLP-1 participants². Meaning that for every 1 out of 5 people trying to lose weight, their only path is the tried-and-true approach of making healthy lifestyle changes. Happy Holidays!

Snark aside. Technology has completely revolutionized lifestyle management programs. Not only do individuals have a wealth of knowledge and guidance at their fingertips, digital coaches are more personalized than ever and can be accessed on-demand, 24/7. For employers, the cost, convenience and proven results of behavior change and lifestyle management programs won’t be replaced with medication-only approaches any time soon.

‍Emerging Trend #2: Directly-contracted point solutions and niche vendors are going out of style

During the point solution boom of the late 2010s and early 2020s, employers were filling their niche benefit offerings by directly contracting with vendors. The benefit vendor landscape also ballooned during this period. A crowded landscape means not only more vendors to sift through, but benefit leaders started to feel the strain on internal resources from the efforts needed to contract with, implement, onboard, administer and maintain each individual vendor. 

That said, 2025 will be THE GREAT CONSOLIDATION of point solution vendors. Niche vendors "offering only 1 or 2 services" will be replaced with "all-in-one" holistic vendors. Even if the niche vendor is best-in-class, employers will be happy to swap one “A” capability to a holistic vendor with many “B” capabilities. Plus, as access to benefit vendors becomes increasingly more available through an employer’s health plan or PBM, expect employers to leverage these relationships to streamline contracting and offset their resourcing burdens. 

‍Emerging Trend #3: Buyer Beware- The compounded medication conundrum is only going to continue

Compounded medications are quite a controversial topic. Due to the demand of GLP-1 medications, compounded versions of the medications are (literally) “popping up” on the internet. As a mile-high overview, compounded medications are medications that don’t need to pass FDA approval to be manufactured and sold. While there are plenty of restrictions on when compounded medications can be produced, the pro-compounded crowd touts compounding as a way to make medications more affordable and available. The anti-compounded medication crowd warns about the dangers of “safety, quality and effectiveness” of the drugs³.

A recent experiment shows both sides have merit. Out of 11 compounded medications tested; one medication contained 0%, ZERO PERCENT of the actual medicine; two medications fell below the 90% threshold (weaker than non-compounded); six medications contained 90%-110% of the medicine (comparable to non-compounded); and two medications contained more than 250% of the medication⁴. For medications known to already have unpleasant side-effects, 250% could put a person in a world of discomfort, if not worse. 

But that’s the main issue with compounded medications, you never know what you’re getting. The six medications that fell within the correct thresholds aren’t guaranteed to consistently have that level of quality. At the end of the day, even compounded medications sold by reputable companies are still unregulated. Bottom line: Always consult with a medical professional before taking any medication, especially compounded medications!!!!

‍Emerging Trend #4: GLP-1 coverage will grow as research finds new uses for the medications

We’ve seen this story before. A medication gets developed to cure a condition, but as time passes, new research discovers alternative uses for the drug. For example, take the drug Bupropion, commonly known as Wellbutrin. Originally released as an antidepressant, it’s now also used to treat generalized anxiety disorder, aids in smoking cessation and is even prescribed in combination with another medicine for weight loss.  

While the primary FDA use for GLP-1 medications is still centered around diabetes and obesity, potential future uses could treat cardiovascular disease, high blood pressure, high cholesterol, angina (chest pain), and potentially even addiction⁴ and Alzheimer's⁵. It is pretty safe to say that the more versatile the outcomes for these medications are, the more pressure there will be for employers to cover them. 

‍Emerging Trend #5: Cost containment strategies will heavily influence GLP-1 coverage decisions

GLP-1 coverage across the board is still relatively straightforward: covered for all weight loss, on-label coverage only or no coverage at all. We’ve already seen examples of employers who attempted to cover the medications for all weight loss experience dramatic increases in pharmacy spend and therefore, remove the coverage¹. Employers are increasingly seeking sustainable GLP-1 coverage strategies. Enter the concept of cost containment.

Think of cost containment as a series of strategies aimed to identify the most successful candidates for coverage. In this case, success isn’t related to how someone will respond to the medication (revisit Trend #1), success is predicated on determining which candidates will put in the necessary effort to have the best outcomes if covered.

For example, say an employer sets a BMI threshold for coverage. Automatically, costs are being contained by the percentage of employees who would qualify. On top of the BMI threshold, this employer also mandates that employees must complete a prerequisite 3-month lifestyle management program. Immediately, employees are going to drop out of the program due to the effort required and save employers on coverage costs. On the other end of the spectrum, you will have employees who have success in the lifestyle management program and then fall below the BMI threshold— disqualifying them from medications and containing more costs. 

With employers facing a 7-8% increase in healthcare costs in 2025, “some of the highest in decades”, and GLP-1 medications being a major contributor to this increase⁶, expect employers to seek new approaches to mitigate these rising costs. Cost containment strategies will be at the top of this list. 

In conclusion, the future of GLP-1 medications in employee health plans is poised for a significant evolution. As research expands the potential uses of these drugs and cost containment strategies become more sophisticated, employers will need to navigate a complex landscape of benefits and risks. The coming year will likely see a more nuanced approach to GLP-1 coverage, balancing the proven benefits of these medications with the enduring value of lifestyle management programs. As always, the ultimate goal remains improving employee health outcomes while managing healthcare costs effectively.

¹https://www.lark.com/resources/2024-hlth-recap-glp-1s-going-under-covered-panel

²https://apnews.com/article/wegovy-zepbound-obesity-drug-nonresponder-glp1-9f8ab517f26ccc6d2d32ce3e829ba8ff#:~:text=For%20some%20patients%2C%20that%20just,game%20over%2C%E2%80%9D%20Dushay%20said.

³https://www.benefitspro.com/2024/12/06/diabetes-association-cautions-on-compounded-glp-1s/?kw=Diabetes%20Association%20cautions%20on%20compounded%20GLP-1s&utm_position=4&utm_source=email&utm_medium=enl&utm_campaign=bprodailynews&utm_content=20241209&utm_term=bpro&oly_enc_id=2548C2820412I8W&user_id=fad397152da2f17a5d78f91ff444223695818146c8988e57d5539864ecc7b169

⁴https://abc11.com/amp/post/how-lose-weight-abc-news-tests-potent-online-compounded-drugs-like-ozempic-wegovy-mounjaro-zepbound/15586570/

⁵https://pennstatehealthnews.org/2024/04/qa-can-weight-loss-drugs-help-in-addiction-treatment/

⁶https://aaic.alz.org/releases-2024/glp-drug-liraglutide-may-protect-against-dementia.asp#:~:text=Cognitive%20function%20was%20calculated%20as,Edison%20said.

⁷https://finance.yahoo.com/news/glp-1-drugs-catastrophic-claims-134219144.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cucGVycGxleGl0eS5haS8&guce_referrer_sig=AQAAACwfg3YjzuljIf49BHqzMpeOgTisIwPt-23x687Djyjg9gl5xyggbRJBW_ZtfNZOSqY3aU5eVlmO7iMYLiPQugiOxQRhWkF450pyFNTwqX0SNdIr0dGyFSRHSnOjxjkfvdcXRUFtCP-yo8QBtMUB3DHe46jb1id1uv9zTKBgWnjr