GLP-1 Pill: What Employers Need to Know About Costs, Coverage, and Outcomes

While previously available only as an injectable, this daily oral tablet offers a needle-free alternative that could drastically increase adoption rates. For employers and benefit plan sponsors, this brings a new set of considerations. Everyone is now wondering if and to what extent employer health insurance plans will cover this medication, and what are the financial implications? These drugs promise significant weight loss outcomes, and the upfront cost has been a massive barrier for many looking to take them. 

While we are still waiting for many of the details to be worked out by the insurance carriers and pharmacy benefit managers, there are important considerations that are back again in front of employers; cost and outcomes. The Wegovy pill is significantly less expensive than its injectable counterpart. The cash price is $149 per month for the first two months, then $299 thereafter. In contrast, Wegovy injections have a list price of $1,300 or more per month. The second consideration for employers is the potential long-term savings and improved health outcomes because of members using this medication. Better health management can lead to lower health care costs and savings to the company’s health plan.  

Obesity is a major risk factor for numerous chronic conditions, including type 2 diabetes, heart disease, certain cancers, and musculoskeletal problems. These conditions bring about expensive prescriptions and treatments, and if not managed properly, many of us have seen how this can affect both the health of employees, and hefty year-over-year premium increases. By effectively managing weight, these drugs could lead to a reduction in claims costs associated with these co-morbidities. Short-term studies have shown impressive weight loss results, which could translate into fewer doctor visits, hospitalizations, and prescriptions for related conditions down the line. The challenge lies in quantifying these potential savings and clearly demonstrating the value of covering this type of medication.  

For employers, the goal should be to offer comprehensive benefits that support overall employee health and productivity. It is important to understand the full scope of this drug’s impact and to make informed decisions that align with organizational goals and employee wellness strategies.  

OVD is deep into the evaluation with our clients, and we will keep you up to date as this news continues to develop. Please reach out to an OVD benefits advisor with any questions you may have!