How One Employer Avoided Unnecessary Spending on GLP-1 Medications

Enjoy this featured content from our partner, MultiPlan.

How MultiPlan’s BenInsights™ Platform helped to manage healthcare benefits through data-backed trend analysis

GLP-1s (Glucagon-like Peptide 1) have exploded in popularity in recent years, and therefore have caused employer claims costs to rise exponentially as well. In a recent case study titled, Plan Sponsors Navigate Usage and Coverage of Ozempic and Other GLP-1 Drugs, MultiPlan reported their findings of one employer who was able to cut unnecessary spending on common weight loss medications.

The Situation

The use of Ozempic and other GLP-1 diabetic drugs for weight loss purposes has gained attention in the context of employer-sponsored health plan coverage. Employers are struggling with making appropriate benefits design decisions around the GLP-1 medications used for this purpose.

The Problem

The average cost for Ozempic and other GLP-1 drugs before insurance ranges from around $900 to over $1,000 per month. With employer-sponsored health plans, employers are responsible for most of the costs. According to data accumulated through MultiPlan’s BenInsights™ Platform, we saw 80% year-over-year spend increase on the GLP-1 drugs in 2023, averaging $162 per member per year. Employers hoped the spend on GLP-1 drugs could help their members better manage type-2 diabetes and other comorbidities and deter them from becoming high-cost claimants, but the challenge was first identifying who should not take GLP-1 drugs.

The Actions

Using the BenInsights platform, the employer easily identified the uptick spend on GLP-1 drugs and quantified the financial impact of inappropriate GLP-1 drug use.

Identified inappropriate GLP-1 drug usage

By aggregating medical and pharmacy data on the BenInsights platform, our Smart Card quickly identified members using GLP-1 drugs who did not have a medical diagnosis of diabetes or obesity in the past 24 months.

Recommended prior authorization review by PBM (pharmacy benefit managers)

The employer sent a list of members who were inappropriately using GLP-1 drugs to their PBM, which conducted a second prior authorization review on each individual.

The Results

This analysis helped the employer avoid future spend on inappropriate use of GLP-1 drugs. Further, BenInsights continues to monitor overall healthcare spend and health outcomes of members using GLP-1 drugs.

Download a PDF version of the MultiPlan Case Study

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