Rising prescription drug costs are a major concern for employers, and GLP-1 is partly to blame. The drugs – while very effective – come with a high price tag, forcing many employers to make difficult decisions about GLP-1 coverage for weight loss.
Aware of this, Eli Lilly spear Lilly Employer Connect Thursday, a platform that offers tailored coverage options for obesity care in partnership with more than 15 digital health companies. However, while the platform offers more flexibility to employers, it’s not a monumental improvement, according to at least one expert.
Lilly Employer Connect partners (called program administrators) range from benefits administration to more holistic obesity care models with wraparound support. They include 9amHealth, Andel, Calibrate Health, Crux Health, eMed, FlyteHealth, Form Health, Goodpath, GoodRx, Ilant Health, Mark Cuban Cost Plus Drug Company, Onsera Health, ReviveHealth, SALTA Direct Primary Care, Sesame, Teladoc Health, Transcarent and Waltz Health.
Employers choose which provider they want to contract with and gain access to Lilly’s Zepbound Kwikpen at a discounted price of $449 for all doses. Total costs to the employer depend on their choice of pharmacy and program administrator. The fees paid by patients vary depending on the cost-sharing model the employer chooses with the program administrator, so the price employees pay for the drug is likely less than $449. The typical price for a one-month supply of Zepbound ranges from $299 for 2.5 mg to $699 for 15 mg.
“Lilly is working to close the gap in access to obesity care. With nearly half of commercially insured Americans lacking coverage for obesity medications, we recognize that employers need flexible, transparent solutions that complement existing benefits,” said Kevin Hern, senior vice president of Lilly Employer, in an email.
An employer advocate is excited to see innovation around direct-to-employer drug offerings, noting that this program helps employers move away from the rebate-driven model offered by most large PBMs, which have fallen under scrutiny for their lack of transparency. However, Eli Lilly’s program brings small advances but nothing major.
“It’s not revolutionary, but it shows incremental improvements in flexibility for employers looking to provide access to these high-cost medications that are increasingly in demand by employees,” said Shawn Gremminger, president and CEO of the National Alliance of Healthcare Purchasing Coalitions. “The price is competitive but does not appear to be significantly lower than what employers were already getting.”
The real change with Eli Lilly’s program is the more flexible approach to providing GLP-1s to employees, Gremminger added.
“The evolution here has been radical,” he said. “Two years ago, pharmaceutical companies and PBMs worked together to combat independent providers offering discounted GLP-1, in coordination with increased health oversight and oversight, to the point where employers lost their rebates if they hired one of these providers. Today, GLP-1 manufacturers are fully embracing this approach and working with providers and employers to provide greater access to these drugs.”
Another healthcare expert, meanwhile, said the Lilly Employer Connect platform gives employers more control, more choice and greater clarity on costs. She added that this also reflects the rise of digital and direct-to-consumer platforms that have recently gained traction to increase access to GLP-1s.
“At the same time, the market is likely heading toward price compression as competition increases from digital/direct-to-consumer players, specialty compounds and new small-molecule oral options entering the obesity treatment space,” said Beth Mosier, director of healthcare M&A at consulting firm West Monroe. “Lilly recognizes both the scale of market opportunity and the economic impact of obesity, which contributes to more than $1.24 trillion in lost productivity.”
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