Bass, Berry & Sims attorneys Susie Bilbro and Catherine Simpson authored an article for SHRM providing insight on how plan sponsors can go beyond the conventional pharmacy benefit manager channels to reduce the significant costs of GLP-1 medications for employer-sponsored health plans.
Direct-to-consumer programs are a promising model if GLP-1 coverage is removed from the plan’s standard formulary. Patients are redirected to specialized weight management vendors, and then participants can fill prescriptions at lower prices through direct-to-consumer pharmacies, which typically have lower prices than those negotiated through PBMs. From there, they can submit for plan reimbursement. However, plan sponsors must review whether existing PBM arrangements permit formulary modifications.
Susie and Catherine offered four ways to structure the program, including:
- Health reimbursement arrangement (HRA)
- Excepted benefit HRA (EBHRA)
- Health flexible spending account (health FSA)
- A carve-out from the group health plan
“The GLP-1 coverage challenge isn’t going away,” noted the authors. “But with careful planning, employers can manage costs without leaving employees — or compliance — behind.”
The full article, “GLP-1 Coverage: Solutions for Managing Weight-Loss Drug Costs,” was published by SHRM on June 15 and is available online.