GLP-1 Drug Impact on Employee Health Plans

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GLP-1 Drug Impact on Employee Health Plans.
Ozempic and Mounjaro are the two main GLP-1 medications used to treat Type 2 Diabetes. Wegovy and Zepbound are the two main GLP-1 medications used to treat obesity.
GLP-1 medications account for 9% of an employer's prescription medication spend on average, yet only 1.7 percent of plan members are on GLP-1 medications.
Twelve percent of US adults have type 2 diabetes and 42 percent of US adults are obese, so if only 1.7 of plan members are on GLP-1s, then their overall prescribing is just barely getting started.
GLP-1 medications cost $9,000 to $10,000 per person per year after PBM discounts and rebates. They comprise two of the top four medications by total overall spend by employers.
Strategies to Lower Spending on GLP-1s by Employers Include:
1) Prior Authorization - HOWEVER, if an employer chooses to only cover GLP-1 medications for plan members above a certain BMI, then the pharmaceutical manufacturers will refuse to pay them rebate dollars--thus raising the overall cost of the medications.
2) Step Therapy
3) Non-Coverage
Alternatively, GLP-1 medications pose such a great financial burden to employers that they may agree to a single-payer healthcare system run by the Government as a way of addressing the problem.
Sources:
www.wtwco.com/...
blog.ifebp.org...
www.cnbc.com/2....
www.biopharmad...
www.businessgr...
www.biopharmad...
www.goodrx.com...
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Опубликовано:

28 сен 2024

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Комментарии : 34

@4242brvrdbd 25 дней назад

You are explaining some of the most overwhelming and confusing topics.. and it’s making sense!

@ahealthcarez 25 дней назад

Thank you for watching and for your feedback.

@suemilkbone4868 25 дней назад

Dr. Bricker, I think you are right that it is going to take the employers of the US to finally push single payer in America. They are the ones with the influence and power to make such a change happen. Eventually, something has got to give.

@ahealthcarez 25 дней назад

Thank you for sharing your thoughts.

@mjbluth 24 дня назад

Why the reupload?

@ahealthcarez 24 дня назад

I made a mistake in the first version that I needed to correct. Thank you for watching.

@SpecialK711 25 дней назад

Once the patents on these meds expire, ETA 2025+ the $price will come way down, & become much more competitive & attainable.

@ahealthcarez 25 дней назад

Thank you for sharing your perspective.

@robert1200 25 дней назад

The patents on Tirzepatide and Semaglutide still have until the 2030s

@drartithangudu 25 дней назад

Yes parents still have a while on the weeklies. Liraglutide’s parent is up but we haven’t seen a generic yet.

@SpecialK711 24 дня назад

@@robert1200 Unless you can get it from China where they expire in '26

@SpecialK711 24 дня назад

@robert1200 unless you can get it from China starting in 2026

@Trun1782 25 дней назад

Thank you

@ahealthcarez 25 дней назад

Thank you for watching.

@brendagreen8607 25 дней назад

Excellent breakdown. The employers are the only ones with enough power to drive change - but it will take critical mass to go against the behemoth payers.

@ahealthcarez 25 дней назад

Thank you for watching and sharing your thoughts.

@cxvzf 20 дней назад

Thanks for posting! I’m not sure if anyone else notices but there’s a high pitch sound in this video and it’s hard to concentrate with the squeak.

@ahealthcarez 20 дней назад

Thank you for your feedback.

@billeberhart6606 25 дней назад

I love how you make the topic of healthcare so exciting and energized & how informed I feel after watching your videos. We have two small businesses and health insurance is just too expensive for us to buy to even offer to our staff.

@ahealthcarez 25 дней назад

Thank you for watching!!

@regularguy428 24 дня назад

Hi Dr. Bricker, I am big fan and love your videos. Thank you for everything you do. Would you happen to know how to get in touch with a healthcare coach that can help me with these concepts?

@Sokrabiades 24 дня назад

This is not my field at all, but i always like to stop by this channel to learn a bit more about these topics.

@ahealthcarez 23 дня назад

Thank you for watching.

@NANA-nd1kq 25 дней назад

or, offer employees $5000 (half the cost of GLP-1) if achieving proven weight loss above defined threshold in a year? 'Tragedy of Commons' very applicable. Rationing strategy already in place, but workarounds are destroying the grass. (Posting signs: "No Grazing under certain conditions" are being ignored). Political regime owns the commons. Regime will not, evidently, allow perfectly reasonable solutions: catastrophic care 'insurance' coupled with HSA (shop around for competitively priced, best value goods and services...with 'your own money'). Will Regime be made to follow its own rules under single payer system? Or will insiders have access to a velvet-roped VIP treatment area?

@robert1200 24 дня назад

The statistics for weight loss without a GLP-1 or bariatric surgery are pretty dismal. Most people will lose the weight if they try hard enough, but then gain it right back

@NANA-nd1kq 24 дня назад

@@robert1200 Don't they need to (continue to) eat less in either case? Why not offer a choice of cash in hand (in an amount which would also 'benefit the commons')? Are you suggesting people are so willfully ignorant and selfish that they would insist on 'the commons' risking extinction rather than take a somewhat significant personal reward offered for good behavior?

@drartithangudu 25 дней назад

As an endocrinologist who directly contracts with many employers for diabetes and endocrinology care, I face the GLP1RA dilemma daily. The meds are simply too expensive. Ozempic is less than $100/month in many other countries outside the US. These meds are highly effective and transform the lives and health of many of our people living with diabetes. They are also abused. None of our employers cover for weight loss alone. One thing that we also need to consider is the cost of diabetic complications (can be hundreds of thousands to millions of dollars) and how these meds are effective at prevention. There are outcomes beyond glycemic control and weight loss like cardiovascular and renal risk reduction. This is a complex conundrum that would be fairly easily solved if the price on the drugs was not so criminally bloated.

@SpecialK711 24 дня назад

@@drartithangudu 100% agree

@ahealthcarez 24 дня назад

Thank you for sharing your experience.

@DrDarkStar68 24 дня назад

Why is the obligation of private payers and Medicare (taxpayers) to subsidize the metabolic syndrome pandemic, resultant from behavioral decisions of our patients?

@SpecialK711 24 дня назад

Many would assert that the genetically modified food sources and faulty food pyramid endorsed by FDA in 80's is what fueled the hormone disruptor - obesity issue now being uniquely seen in U.S. more than any other nation.