Managing GLP-1 plan exclusions

According to recent surveys from the IFEBP, most multiemployer and insurance carrier plans in the U.S. currently exclude Glucagon-Like Peptide-1 (GLP-1) agonists drugs from coverage for anything other than diabetes. With only 26% providing coverage of these drugs for obesity or weight loss. This is often due to the high cost of these medications, which can place a significant financial strain on medical plans and its participants alike.

The cost of GLP-1s remain high for many reasons:

High consumer demand
Stockpiling or wasting of medications (often due to not tolerating side effects)
Low availability due to supply and manufacturing issues
The need for increased dosages and remaining on the medication once on
A generic is not yet available

Multiemployer groups regularly weigh how to best manage all types of high-cost claims, with an exclusion and/or limitation of GLP-1s being among these considerations. A Board may ask: Is the drug a fad, or something here to stay? Should we offer or require wellness programs or nutritional counseling? Is it worth the monthly drug spend?

Has your plan grappled with how to manage participant expectations and alternatives when facing pharmacy exclusions?

Managing GLP-1 plan exclusions

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