Disease Management Employee Benefits Health Care Insurance Multiemployer Prescription Drugs Public Plans U.S.

Multiemployer Plan and Public Employer Coverage of GLP-1 Drugs

Cara McMullin

New Survey Data Reveals Total Reported Annual Claim Representation for GLP-1 Drugs for Weight Loss Is Almost Ten Percent

A new survey report from the International Foundation of Employee Benefit Plans reveals updated U.S. employer and plan sponsor coverage surrounding glucagon-like peptide-1 (GLP-1) drugs. The International Foundation conducted a pulse survey on GLP-1 drugs in May 2024. The information below reflects responses from public employer and multiemployer plans only.

Multiemployer plan sponsors and public employers indicated the following coverage for GLP-1 drugs:

  • 63% provide coverage for diabetes only
  • 26% provide coverage for both diabetes and weight loss

Of those that currently only offer GLP-1 coverage for diabetes, 15% are considering offering the drugs for weight loss.

Plan sponsors indicated that 9.7% is the average representation of GLP-1 drugs used for weight loss in total annual claims for their organization.

Those employers and plan sponsors covering GLP-1 drugs rely heavily on utilization management (82%) to control costs. These techniques include prior authorization and BMI and/or comorbidity requirements. Less common cost-management approaches include step therapy (29%) and eligibility requirements (21%). Seven percent of employers have no cost-control mechanism in place.

When I spoke withJulie Stich, CEBS, Vice President of Content at the International Foundation, she said that with the release of new FDA approvals and clinical studies, and increasing demand and awareness, plan sponsors are seriously considering how to proceed with drug coverage policies in response.

The most prevalent factors multiemployer plan sponsors and public employers are taking into consideration for GLP-1 drug coverage for obesity care include:

  • 86%—Long-term costs
  • 82%—Obesity as a risk factor for chronic conditions and associated costs
  • 68%—GLP-1 label expansion
  • 64%—Impact/effectiveness of cost-control mechanisms
  • 57%—Lack of clinical studies for long-term use of GLP-1 drugs
  • 50%—Broker/consultant/PBM recommendations.

Responses are reflective of 107 multiemployer and public employer plans surveyed between May 22 and May 29, 2024. Visit www.ifebp.org/GLP1drug2024 for more information and to view the full survey report.

Cara McMullin

Communications Specialist Favorite Foundation Product: Word on Benefits Blog Benefits-related Topics That Interest Her Most: Equity and Inclusion, Workplace Wellness Personal Insight: Cara loves live theatre, concerts, and festivals – lots of fantastic options in Wisconsin. In her spare time, you can also find her reading, streaming TV/movies and spending time with family and friends at local restaurants, outdoor concerts, and farmers markets.

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