New medications like GLP-1 receptor agonists, originally developed for diabetes and now widely prescribed for weight management, are reshaping conversations in health care. For employers, these treatments present both an opportunity and a challenge. While they can significantly improve employee health outcomes, they also carry high costs that may strain benefit budgets.
Tooher-Ferraris Insurance Group understands that effective benefits planning requires more than reacting to rising drug expenses; it’s about proactively structuring coverage to balance affordability with access. Our tailored employee benefits solutions in Connecticut help employers evaluate GLP-1 coverage, optimize PBM strategy and stop-loss, and control costs while safeguarding employee health.
Why GLP-1 Medications Matter for Employers
GLP-1 medications, including semaglutide-based drugs such as Ozempic and Wegovy, have been shown to reduce A1C levels, support weight loss, and lower risks for cardiovascular disease. The clinical outcomes are promising, particularly as obesity-related conditions cost U.S. employers more than $147 billion annually in lost productivity and medical expenses. Supporting employee access to effective treatments can improve long-term health, reduce absenteeism, and strengthen workforce performance.
However, these benefits come at a steep price. Monthly costs for GLP-1 medications can exceed $1,000 per patient, creating difficult decisions for employer-sponsored health insurance plans. The challenge lies in balancing improved care with sustainable cost management.
5 Considerations for Your Benefits Strategy
Below are five key factors to guide your benefits strategy and manage the impact of GLP-1 medications effectively.
-
Understand the Financial Impact
Employers need to assess how covering GLP-1 medications affects their overall health insurance plan spend. A cost analysis should account not only for prescription coverage, but also for potential savings from reduced hospitalizations and fewer obesity-related claims.
-
Explore Step-Therapy Programs
Some health plans adopt a step-therapy approach, where employees first try lifestyle programs or lower-cost treatments before GLP-1 prescriptions are approved. While controversial, this approach can help control costs while still offering access to the medication when clinically necessary.
-
Leverage Data and Benchmarking
Claims data and benchmarking tools can highlight utilization patterns and help employers compare their plan performance with peer organizations. This information supports evidence-based decisions on formulary design and eligibility criteria.
-
Promote Holistic Wellness Programs
Medication alone does not solve the broader challenge of obesity and related conditions. Employers should reinforce GLP-1 coverage with wellness initiatives such as nutrition counseling, weight management programs, and fitness incentives.
Integrating medication with supportive resources enhances outcomes and builds a culture of health.
-
Communicate Clearly with Employees
Employee education is essential. Confusion around eligibility, coverage limits, and copay requirements can lead to frustration. Transparent communication ensures employees understand the resources available and how to access them, improving satisfaction and compliance.
Balancing Cost and Care
There is no one-size-fits-all solution. Employers must weigh the immediate cost burden against the long-term benefits of healthier employees and reduced chronic disease claims. The most effective strategies combine financial controls with a commitment to employee well-being.
Partner with Tooher-Ferraris Insurance Group for Smarter Benefits Solutions
Your workforce deserves care that supports their health without overwhelming your budget. At Tooher-Ferraris Insurance Group, we recognize the challenges employers face in balancing cost and care within their benefits strategies. Our team of employee benefits consultants provide research-driven guidance and tailored employee benefits solutions to help organizations manage expenses while supporting access to effective treatments like GLP-1 medications.
With our expertise, you can design an employee benefits program that safeguards your budget, promotes employee health, and strengthens your organization’s long-term success.
Contact us today to explore tailored solutions for your organization.