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Should employers cover GLP-1s? Three considerations from a chief medical officer

By James Wantuck, MD, chief medical officer of Accolade & PlushCare | July 11, 2023 | 5 min read

In both my role as a practicing physician and business leader, I shape clinical strategy for employers across the country and a large virtual primary care practice with hundreds of physicians. In these capacities, I have the privilege of caring for people managing chronic illnesses and have the opportunity to advise employers that grapple with complex questions and concerns. In recent months, weight management and the search for healthcare guidance on promising GLP-1 drugs has become a frequent topic of discussion. Patients are looking to improve their health and, ultimately, their quality of life, while employers are wondering how they should address GLP-1s as part of their health benefits offering.

The current swirl of debate in the news media and in the market raises questions about the cost and appropriate utilization of GLP-1s. This has left some employers pondering about whether they should cover these drugs at all. As HR (Human Resources) and executive leaders strive to make informed decisions about their company’s policy and coverage, I consistently see good intentions from HR teams as they seek to care for employees in a financially sustainable way.

Forty-two percent of Americans are affected by obesity — a complex health condition that often includes comorbidities like diabetes and joint and heart disease.[1,2] Thus, obesity is a condition that can drive up healthcare costs and drive down quality of life and productivity. When you combine the prevalence of this condition and its resulting costs, the ramifications of how employers manage the GLP-1 question in their benefits design may be the most critical benefits decision they make this year.

Of course, that statement might raise your pulse, so allow me to propose that the swirl of GLP-1 debate may be pushing decision-makers into a false dichotomy. There appears to be an implied pressure to either 1) make potentially life-saving pharmaceuticals broadly available to employees without restrictions or 2) avert potentially unending and unsustainable healthcare spend increases by not covering the drugs carte blanche or by imposing strict limitations. Let us examine a more nuanced approach.

Three GLP-1 considerations to address

If GLP-1s feel like an urgent and precarious issue for which you are unprepared, allow me to offer three prudent and practical factors to consider as you move forward.

1. Obesity is expensive. Mismanaged GLP-1 approaches will be, as well. Roughly 78% of employers have historically not covered weight-loss drugs – perhaps due to now outdated views that weight is a purely cosmetic problem or because the lack of compelling clinical results made it difficult to formulate an employee health plan business case — you may find yourself needing to revisit previous conversations with your CFO. Of course, if you run some basic back-of-the-napkin math, you and your CFO will realize quickly that GLP-1s are not sustainably affordable for all populations. Does this, however, mean that the case for GLP-1 coverage is closed?

From a physician’s point of view, consider that we now know obesity is a bio-social health condition, not a lifestyle choice. It is a result of your genetics, your psychology, and your mental and physical environments. Clinically, we also know that obesity is closely associated with other chronic illnesses, and that collectively these illnesses cost a staggering 9.3 percent of the U.S. gross domestic product. Add to this the interconnectivity of obesity and other health conditions that employers are already paying for, along with the promise of what GLP-1s deliver that previous weight loss pharmaceuticals did not, and you have a circumstance that demands a fresh look.

Not only does a jump to restrict GLP-1s not solve the total cost of obesity that employers already bear, but it is also an approach that may prevent employers from enjoying the benefit of short- and long-term cost reductions. A forward-looking organization would do well to assess the needs of its employees, the clinical considerations and the organizational fit. If you want to address the cost of diabetes, heart disease, cancer, and even orthopedic surgery, you should start by addressing the underlying cause of a large portion of these conditions: obesity.

2. Center on the doctor-patient relationship with your GLP-1 policy. Doctors wrote more than 500,000 prescriptions for GLP-1s in February, an increase of 152% from the year prior. As we know by now, consumers have pursued these drugs even when it meant paying 100% of the cost out of their own pocket. While you evaluate how GLP-1s fit into your benefits offering, consider that while they may sit in your Rx spend line-item, prescriptions are written by physicians who are best qualified to determine if GLP-1s are the right fit for your employee.

I believe that primary care doctors (PCPs) are best positioned to view the full picture of an employee’s health and order the bloodwork and other diagnostics necessary to determine who will benefit from GLP-1s. It is important to put PCPs, who form trusting relationships with patients and have expertise and sound judgement, at the center of employee health decision-making, not solely pharmacy benefit managers or health plans.

3. If you are not already, embrace virtual advanced primary care in your health benefits plan. You might be reacting to consideration number two above by asking several questions. “Isn’t the primary care system struggling?” "Aren’t telehealth companies just pill mills that churn out GLP-1 prescriptions with no thought to the long-term improvement of the patient’s health?”

The concerns behind these questions are valid, and they underpin the final consideration for leaders grappling with the promise and challenges of GLP-1s. As you weave together your provider network and point solution benefits – e.g., diabetes care, MSK programs, center of excellence for heart health – that will work together to address the total health, and total costs of health conditions related to managing weight, consider how they can more effectively work together in an advanced primary care model.

We are here to help you develop a GLP-1 strategy

Accolade’s advocacy-led virtual advanced primary care model, which has proven population health results in both clinical outcomes and cost trend reduction (explained in this video in under two minutes by my colleague and chief health officer, Dr. Shantanu Nundy) provides a map for how to effectively incorporate GLP-1s. It is a new class of groundbreaking medications, but not a silver bullet and must be part of a comprehensive population health plan that puts advocacy-embedded primary care at the helm. Accolade can serve as a strategic extension of your benefits team. Reach out to us today to learn how.



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