The opening sessions of this year’s BenefitsPRO Broker Expo in Chicago kicked off with one of the year’s hottest topics: GLP-1 drugs. According to JAMA, spending increased 500% between 2018 and 2023, surpassing $70 billion.
Those numbers may not matter much to employees more concerned with the numbers they see on the scale, but they do to employers. Already burdened by rising healthcare costs, they have to wonder: Is it worth it?
“Is it possible that we are spending millions of dollars on medications for our diabetes population and they are still sick?” asked Ben Conner, CEO of Conner Insurance. Conner opened the session with a case study showing how his firm partnered with a wellness coach and PBM partner to build a data-driven strategy to help employees better manage diabetes.
“When we looked at our pharmacy situation across the book of business—how we’re spending money on specific conditions—diabetes was in and around 10 times more than any other group,” Conner said.
The result was some numbers that should be more encouraging to employers: a million dollars in medical spend savings in the first year; a 19% decrease in PMPM for plan members with diabetes; A1C levels among the highest-risk employees dropping from 11.3 to 8.5; and 60% of program participants trending toward diabetic remission.
With focus on weight loss, GLP-1s’ role with diabetes overshadowed
With so much of the focus on GLP-1s as weight-loss drugs, their original role in managing Type 2 diabetes has been overshadowed—somewhat intentionally.
“What we have seen is that manufacturers want employers to cover these medications, no questions asked,” said Betsy Bigler, president and COO of Northwind Health Company. “They did not want you to ask anything—not confirm a diabetes diagnosis or anything.”
In many cases, that leaves employers carrying GLP-1 costs without a clear return on investment. “We’re finding that it does take a triage period to find out why people are on GLP-1s,” Bigler added. “You have GLP-1s for Type 2 diabetes, you have it for prediabetes and you have it for weight management.”
Taking this perspective means that benefits advisors and employers can work together and formulate a plan, with measurable objectives. And drug spend goes from being a line item to a piece of a bigger puzzle.
“If you have diabetes, you don’t get cured, you go into remission,” Conner said, likening it to cancer treatment. “If someone is on chemo and they go into remission, they’re going to go into a different treatment regimen. We approach diabetes the same way.”
One org excluded GLP-1s from PBM, opting for a specialty version
As part of their strategy, Conner Insurance and the employer decided to actually exclude diabetic medications like GLP-1s from the employer’s PBM, instead opting to set up a specialty PBM through Northwind, pairing it with a mandatory health coaching program. In exchange for participating in this arrangement, employees would have their co-pays cut in half for brand-name drugs and eliminated for generics.
Another stat: Buy-in among the company’s diabetic population was 90%.
“We’re borne out of an engagement strategy,” Bigler said. “How do we marry that with health coaching and pharmacy engagement? These are people that we want to live good lives and take really good care of these employees.”
Along with wellness services from Spire Wellness, the strategy was able to identify objectives. “One of the first things you have to do is have a baseline,” explained Kelly Fenol, managing director with Spire Wellness. “If you don’t know where you’re starting, how are you ever going to get a delta? Where do we move financially and for the health of the population? What does that look like? What are the financials?”
By defining what the objectives were and the specific strategies to achieve them, they were able to define and measure success. “We can tell you, with this client, what percent of our folks with a diabetic condition are high risk, what percent are filling GLP-1, what’s our engagement percentage, cost per patient, all of those things that are really key performance indicators for success,” Conner said.
For the employer, all of this added up to $1 million in reduced health care spending in the first year—while improving the overall health of their employees. “We also saw almost 60% of the population after just one year approaching diabetes remission,” Bigler said. “These are people who are taking better care of themselves. They’re teaching their kids better habits as well.”
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