Understanding GLP-1 Medications and Increasing Utilization
GLP-1s, or glucagon-like peptide-1 agonists, are a class of medications seeing increasing effectiveness in managing Type 2 diabetes and obesity, with the potential to impact other medical conditions as well.
As a result, as interest and utilization of these expensive drugs have increased, so has the fiscal burden on employers providing their members’ pharmacy benefits.
To better understand how GLP-1 medications are impacting the pharmacy and healthcare space, Truveris has created resources to support employers and benefits professionals in building out comprehensive strategies to manage GLP-1 costs:
- eBook: Strategies for GLP-1 Management in Pharmacy Benefits
- Article: How Pharmacy Plans Are Managing GLP-1 Coverage
- Managing GLP-1 Costs Webinar: Coverage Strategies
- Case Study: Identifying Incorrectly Billed GLP-1 Claims
Resources for Managing GLP-1 Coverage and Spend
1. Strategies for GLP-1 Management in Pharmacy Benefits eBook
In this comprehensive eBook, Truveris experts offer an educational look at GLP-1s and their growing pipeline as pharmaceutical manufacturers invest heavily into R&D to increase indications and fill the demand for these drugs.
This resource also shares step-by-step considerations employers need to keep in mind when planning for GLP-1 coverage, including examples of how public entities and employers are already structuring or restructuring their benefits to account for these medications.
Finally, our experts offer several metrics that employers should monitor on an ongoing basis to stay apprised of their GLP-1 utilization and spend:
- Gross/Net Cost to the Plan
- Number of Utilizers (including new utilizers over time)
- Number of claims (including adherence trends and refill patterns)
2. How Pharmacy Plans Are Managing GLP-1 Coverage
In this blog, Truveris experts break down 4 timely methods that employers are using to mitigate the high cost of GLP-1s while increasing appropriate access to members who need it most.
The four strategies include:
- Utilization Management (UM) with Prior Authorization
- GLP-1 Carve-Out Programs
- Ongoing Claims Oversight
- GLP-1 Claims Audits
By initiating a proactive and thoughtful approach to GLP-1 coverage, employers can adapt to increasing interest and use of these medications while ensuring long-term financial stability for the pharmacy plan.
3. Managing GLP-1 Costs Webinar: Coverage Strategies
In a live presentation and Q&A, Truveris experts shared proprietary data and case study examples from employers needing to make decisions about GLP-1 coverage as costs continue to increase.
Some key takeaways include:
- Truveris data found a 5x increase in spend on GLP-1 medications indicated for weight loss (Wegovy, Zepbound, and Saxenda) from early 2023 to early 2025 (1.1 million claims)
- GLP-1 adherence plus lifestyle changes are crucial to long-term clinical success, as pausing the medications has been found to quickly reverse positive effects of weight loss
- Comprehensive monitoring can be helpful to identify trends and catch contract implementation issues that might negatively impact overall plan spend
4. Identifying Incorrectly Billed GLP-1 Claims Case Study
In this case study, we share how a group of Truveris clients discovered over $250,000 in unintended GLP-1 expenditures mid-contract due to PBM implementation errors.
While the groups had initially asked the PBM to exclude coverage for GLP-1s, the PBM was inadvertently allowing claims to come through, rapidly incurring unexpected costs for the groups.
Questions about GLP-1 drug coverage and pharmacy benefits strategies? Contact Truveris here.
Truveris is a leading digital health company focused on delivering truth and clarity in pharmacy. Truveris’ proprietary technology, coupled with deep pharmacy expertise, helps to build a more efficient market that maximizes choice, accessibility, and prescription drug affordability. Our solutions provide the insight and knowledge to help people lead healthier and more productive lives.
