The rising cost of weight loss drugs, reaching as high as $1,350 per month*, coupled with increasing employee demand, presents a considerable financial challenge for employers. However, the costs associated with glucagon-like peptide-1 (GLP-1) agonists don’t have to spiral out of control. Pharmacy Benefit Managers (PBMs) are critical in curbing the escalating expenses linked to weight management and related chronic conditions. With the right strategies, PBMs can ensure employees receive the most effective treatment at the optimal time contributing to improved health outcomes and cost reductions.
Digital health emerges as a valuable solution, offering a comprehensive toolkit to enhance care management and address cardiometabolic conditions. This technology facilitates a personalized, AI-driven experience, helping to prevent unnecessary medical expenditures. Additionally, digital health coaching and advanced analytics provide flexibility and scalability in population management, further optimizing resource allocation and patient care.
Here’s how PBMs can harness digital health to manage GLP-1 costs:
1. Refine Benefit Structures with Utilization Management
Managing prior authorizations for GLP-1 therapies can be complex due to varying patient needs and shifting clinical guidelines. Streamlining these processes is critical to manage costs effectively and ensure appropriate usage as demand increases. 
Digital health platforms enable PBMs to develop benefit designs that include:
- Digital coaching for weight management.
- Prior authorization processes supported by real-time data and analytics.
- Educational programs focused on improving medication adherence and encouraging behavioral changes before GLP-1 qualification.
- Resources to support patients in adjusting or discontinuing GLP-1 therapy as needed.
2. Employ Data Analytics for Enhanced Population Management
To optimize and measure the effectiveness of digital health integrations, PBMs, and employers need to leverage comprehensive data analytics. Welldoc is advancing its AI-driven platform to provide predictive models that tailor weight loss strategies to individual trends. This approach was recently detailed in the Welldoc framework. By utilizing these advanced insights, PBMs can deploy digital health solutions to accurately customize interventions, effectively identifying individuals who stand to gain the most from GLP-1 therapies.
3. Broaden the Scope of Care Management
The fragmented nature of the current healthcare system often leads to inefficiencies and increased costs. Digital health solutions, such as Welldoc’s cardiometabolic platform, bridge these gaps by providing continuous care beyond office visits. Welldoc’s digital coaching expands existing care programs by integrating real-time data into clinical workflows, which supports lifestyle interventions and nutritional guidance to improve the overall management of GLP-1 therapies.
4. Deliver an Integrated, AI-driven Experience
A robust digital health solution can complement GLP-1 treatment and support the gradual deprescription of these drugs. While employees are on weight loss medications, digital health tools can enhance medication adherence and provide condition-specific coaching. These tools are equally valuable when transitioning patients off medication, promoting lasting behavioral change through sustained educational support and feedback.
Transforming Challenges into Opportunities
By embracing these digital strategies, PBMs can more effectively meet the dual challenges of high costs and complex care needs. Welldoc’s cardiometabolic platform demonstrates how integrating data-driven insights with comprehensive care support can streamline the management of costly, high-risk conditions. This approach benefits patients and provides measurable value to employers and PBMs by enhancing care efficacy and reducing overall expenses.
To discover more about our digital health solutions, connect with us today.
References:
* https://www.jpmorgan.com/insights/global-research/current-events/obesity-drugs
