New Survey Data Reveals Prior Authorization or Other Utilization Management Strategies, Eligibility Requirements, Annual Maximum as Leading Cost Control Methods
A new survey report from the International Foundation of Employee Benefit Plans reveals updated Canadian employer coverage and cost-control mechanisms surrounding glucagon-like peptide-1 (GLP-1) drugs. The International Foundation first conducted this survey in January 2024.
Employers indicated the following coverage for GLP-1 drugs:
- 56% provide coverage for diabetes only (down from 66% in 2024)
- 31% provide coverage for both diabetes and weight loss (up from 17% in 2024).
Of those that currently offer GLP-1 drug coverage only for diabetes, 20% are considering offering the drugs for weight loss (up from 9% in 2024).
When I spoke to Julie Stich, CEBS, Vice President of Content at the International Foundation, she stated, “This new survey data shows that over the last year, GLP-1 coverage in Canada has continued to rise, reflecting a growing interest in these drugs as both a weight loss and diabetes treatment. Organizations are balancing the ongoing demand from employees for GLP-1 coverage for weight loss by continuing to explore feasibility through cost-control mechanisms.”
Cost-Control Mechanisms
Of those covering GLP-1 drugs, employers are using eligibility requirements (45%) and an annual maximum (32%) as cost-control mechanisms. Utilization management strategies continue to be the most heavily relied upon cost-control mechanisms (68%).
Out of those who use utilization management:
- 100% require prior authorization
- 27% require reauthorization for refills
- 13% use a physician-led approach
- 13% limit prescribers by type
- 7% limit prescribers to a telehealth/virtual care vendor.
Coverage Methods
Of those covering GLP-1 drugs:
- 86% offer the prescription drug within their medical plan
- 27% offer the drug through a health care spending account (HCSA)
- 14% offer the drug through a supplemental rider.
Visit www.ifebp.org/CanadaGLP2025 for more information and to view the full survey report.
