Latest / Becker’s Healthcare Podcast / Rethinking GLP 1 Coverage Through Transparent, Consumer First Pharmacy Models

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Rethinking GLP 1 Coverage Through Transparent, Consumer First Pharmacy Models · Becker’s Healthcare Podcast

• 0:02
  This is where health insurance leadership comes together.
• 0:05
  Becker's fourth annual spring payer issues roundtable brings
• 0:08
  together over 400 payer and health plan executives
• 0:12
  and more than 100 speakers to Chicago April.
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  This year's event includes keynote conversations with the
• 0:19
  industry's top leaders and former president George W.
• 0:23
  Bush. For the full agenda and event details,
• 0:25
  visit beckershospitalreview.com
• 0:27
  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  here in Chicago.
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  Hello, everyone. This is Elizabeth Cassello with the
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  Becker's Payer Issues podcast.
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  I'm thrilled today to be joined by Bethany
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  Stein, segment president of pharmacy at Humana.
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  Bethany, thanks so much for chatting with us
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  today. Yeah. Happy to be here. Thanks for
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  having us, Liz.
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  Yeah. So before we jump into the conversation,
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  can you tell us a little bit more
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  about yourself, your health care career background,
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  and what your role is at Humana?
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  Yeah. Happy to do that.
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  Bethany Stein, as Liz said, president of Humana's
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  pharmacy segment, CenterWell Pharmacy. I am a pharmacist
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  by trade,
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  and started at Humana right out of pharmacy
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  school as a resident.
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  So today, I oversee the strategic growth operations
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  and p and l of Humana's three different
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  pharmacy businesses, which include
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  CenterWell Pharmacy, our home delivery pharmacy,
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  CenterWell Specialty Pharmacy, and then Humana Pharmacy Solutions.
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  And I would just add that my team's
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  focus is incredibly simple. Right? We wanna make
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  pharmacy more transparent, more consumer friendly,
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  and more clinically effective at scale.
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  That's great to hear, Bethany, and thanks again
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  for joining us.
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  So the big news I wanna talk about
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  today is how Humana Centerwell Pharmacy is going
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  to dispense Eli Lilly obesity management drugs
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  through its employer plan sponsored carve out programs.
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  What are employers asking for right now when
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  it comes to GLP one coverage, and how
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  does this partnership
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  enable Humana to respond to that demand?
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  Yeah. Thanks, Liz. I love this question. I
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  think employers are in a very different place
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  with GLP one coverage today than even a
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  year ago.
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  The conversation has essentially shifted from should we
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  cover them to how we cover them responsibly.
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  They're looking for predictability,
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  control, and transparency,
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  but without
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  restricting access for the people who truly need
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  these medications.
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  So what we're hearing consistently from employers is
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  that not all GLP one use is the
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  same.
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  Right? So different employee populations
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  have very different clinical needs, whether that's dose
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  escalation,
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  duration of therapy,
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  or just like the type of behavioral support
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  required to be successful.
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  So employers
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  are increasingly asking for benefit designs that stratify
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  populations
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  thoughtfully,
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  rather than treating GLP ones as one large
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  undefined cost category.
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  So for example,
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  some programs that distinguish between
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  high risk metabolic patients that may see the
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  greatest downstream medical savings. Right? A weight only
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  population
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  where employers may want more guardrails and accountability.
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  And then finally, maintenance versus initiation phases where
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  intensity and cost can differ significantly.
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  So that kind of segmentation
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  helps employers move from this broad utilization
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  concern
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  to an intentional strategy where they can support
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  the right patients without runaway spends.
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  And, honestly, Liz, like, the cost pressures are
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  real. Right? A recent Gallagher study showed that
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  GLP one drug class spend increased 35%
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  in 2024
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  and another 25%
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  in 2025.
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  So even with good clinical outcomes, that cost
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  trajectory is truly outpacing
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  the near term medical savings.
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  So employers are rethinking their models and leaning
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  into approaches that give them clear line of
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  sight to both utilization
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  and value.
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  And so, again, going back to
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  integrating segmentation,
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  clinical oversight,
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  and a more transparent pharmacy model, we at
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  CenterWell are really helping employer structure GLP one
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  benefits
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  in a way that meets the moment,
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  sustainable,
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  intentional,
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  and still high quality for their members. So,
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  ultimately, it's about giving employers the confidence that
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  they can offer these important therapies without sacrificing
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  affordability
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  and giving employees
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  a support model that actually helps them succeed.
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  So I would just say that is in
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  general why we are so excited
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  with where we're going in our partnership with
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  Lilly and other various partners within this ecosystem.
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  Yeah. So I was actually going to ask
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  about those other partners just to give context
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  to our listeners.
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  Humana is also working with Novo Nordisk on
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  direct to patient, we go via access.
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  And there's also just beyond that, some recent
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  research points to slowed medical cost growth for
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  g l p GLP one users in the
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  long term.
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  So how do those collaborations
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  with manufacturers
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  so Eli Lilly, like what we're talking about
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  today, Novo Nordisk,
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  work together to bend that cost curve without
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  restricting access? Just elaborating a little bit more
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  on those stratification points that you mentioned earlier.
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  Yeah. I would just say, I think GLP
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  ones are both clinically transformational
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  and financially challenging at scale. Right? And so
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  that's exactly why we're talking about such a
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  deliberate approach.
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  So Humana
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  is building a consumer focused health care company,
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  and pharmacy is a strong expression of just
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  that strategy.
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  Whereas CenterWell Pharmacy, just as as background information
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  for you all, is was built originally for
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  the health plan by the health plan. So
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  from day one,
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  it has been designed around outcomes,
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  transparency, and affordability,
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  not spread pricing, rebate fees, or intermediaries.
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  And so we have results that really speak
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  for themselves in the form of better outcomes.
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  Right? CenterWell patients have
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  15% fewer ER visits and 13%
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  lower hospitalizations
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  than patients using any other pharmacy in our
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  network, and we validate that annually.
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  We see better experience.
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  Right? Our net promoter score is consistently 15
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  points higher than other pharmacies.
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  We we deliver that true transparency. Right? So
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  for thirty years, we've operated with no hidden
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  fees, no gains, and complete visibility for the
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  health plan.
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  And then lastly, affordability
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  is just built into our model. Right?
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  At at the highest level, 90% of our
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  generics cost less than $2 a month, many
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  with no co pay at all.
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  And we truly proactively
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  help members find lower cost alternatives
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  and financial assistance for high cost brands and
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  specialty drugs.
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  So when you combine all that
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  with home delivery
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  scale and a consumer first mindset,
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  you really end up with a pharmacy model
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  that is uniquely aligned to what the GLP
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  one marketplace requires,
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  predictable pricing and clinical integrity.
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  And so that's why we're expanding this model
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  beyond Humana members to a direct to patient
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  pharmacy solution model for GLP ones. And so
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  to get to your question,
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  our collaborations with manufacturers like Novo Nordisk and
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  Eli Lilly are built upon those same principles.
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  We just simplified access at a lower out
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  of pocket cost. And so this truly does
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  bend the cost curve and expand access,
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  and we're doing it
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  exactly how a consumer health care company should
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  do it. Right? Simplifying the ecosystem,
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  removing friction and waste,
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  delivering predictable transparent pricing,
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  improving outcomes and adherence,
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  and scaling safely and responsibly.
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  So we're not restricting access. We're expanding safe,
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  affordable, high quality access
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  while building a cost structure that is sustainable
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  for payers, employers, and consumers over the long
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  term.
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  And I believe that this is really the
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  future of pharmacy care. Right? A consumer centric,
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  clinically guided, transparent,
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  and and it's built to support the next
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  generation of therapies at scale.
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  So I actually wanted to ask a little
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  bit about that adherence point because that is
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  such a concern here.
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  What
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  steps is Humana taking while they're working
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  with employers
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  on promoting adherence?
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  And what what else do you have to
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  say on adherence?
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  Because that is just such a big concern
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  in terms of the cost here.
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  Yeah. I totally agree. And if you if
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  you taking a step back, I would say
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  the strongest support around medication adherence
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  is a lot of the clinical programs and
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  support elements that we have in place today.
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  So just another metric for you. At CenterWell
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  Pharmacy, we see about 260 basis points better
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  medication adherence than we see in other pharmacies
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  in our network. And so our pharmacy is
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  truly incentivized
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  to to focus on adherence because we know
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  there is a ton of downstream clinical impacts
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  related to that. The hospitalizations
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  I mentioned, the ER visits,
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  those are all
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  lowered, and this is well studied in the
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  industry, when patients take their medicines.
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  Right? And so I would say at CenterWell
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  Pharmacy, we have
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  robust medication adherence programs
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  that are in all forms, whether it be
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  reminder calls or having conversations with pharmacists around
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  barriers to adherence.
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  We segment the population
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  on those that are high risk of falling
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  out of medication adherence
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  versus ones who we know may just need
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  a little bit of a nudge or a
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  lower cost intervention.
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  So we've done a ton of research on
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  this. I would say we have a ton
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  of clinical interventions, and I'm really proud of
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  the investments that we have made to support
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  medication adherence
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  because it is a win win solution when
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  members take their drugs. We just see the
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  better better medical outcomes
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  that that result.
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  Yeah. Absolutely. And you mentioned this earlier, but
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  you think that employees are
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  shifting their perspectives on GLP ones at least
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  in the past year.
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  Could you talk a bit more about why
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  now is the time to deepen relationships with
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  manufacturers
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  offering weight loss drugs?
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  Yeah. It's it's a great question.
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  The health care system is under pressure to
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  lower drug costs and expand access. Right? Creating
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  a truly a favorable environment for an alternative
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  benefit model. The system does need a new
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  model,
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  and both manufacturers
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  and employers know that they cannot solve this
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  alone.
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  So the environment,
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  I would say, today makes partnerships like ours
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  especially valuable
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  because they deliver on what the market is
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  demanding right now. But just going back, I
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  mean, GLP ones were definitely the catalyst, and
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  here's why. I mean, one, affordability
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  was and still is a top concern for
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  regulators and legislators,
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  and access to GLP ones
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  were declining.
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  Two, drug shortages at the time exploded. Right?
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  And the market was flooded with compounds and
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  non FDA approved alternatives,
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  creating real safety risks.
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  Three,
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  manufacturers were looking for a way to disrupt,
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  and we became that partner.
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  Starting with our partnership last year with Novo
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  Nordisk for Wegovy,
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  and now with Eli Lilly.
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  Together, we've lowered costs, helped patients avoid unsafe
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  alternatives, and addressed barriers to access and affordability.
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  And I wanted to hear some final thoughts
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  and advice as we wrap up for other
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  industry leaders. And I know
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  you mentioned a lot about what CenterWell does
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  really well, but what advice do you have
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  also for payers that might not have a
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  pharmacy component
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  and what they could be thinking about right
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  now?
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  Yeah. If there were
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  if there's one takeaway from our experience, it's
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  this. The GLP one moment isn't just about
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  GLP ones. It's about rethinking the entire ecosystem
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  around access, access, affordability, and consumer experience.
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  My advice is simple. Right? Start designing
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  for the consumer first. When you build models
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  that prioritize
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  transparency,
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  clinical quality, and predictable cost, you don't just
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  improve access. You naturally bend the cost curve
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  because the system becomes simpler.
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  Second, leaning into partnerships. None of this none
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  of us can solve the drug affordability and
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  access challenge alone.
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  Manufacturers,
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  pharmacies,
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  payers, and employers
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  each control a different lever. So when those
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  work together, like our collaborations with Eli Lilly
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  and Novo Nordisk, you can really create access
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  channels that are clinically responsible,
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  financially sustainable, and scalable.
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  And then just finally,
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  embracing transparency and data.
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  The organizations
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  that win in this space will be the
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  ones who can demonstrate real outcomes,
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  drive medication adherence,
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  and give payers and employers true line of
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  sight into utilization and value.
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  So that obviously requires openness,
• 13:16
  shared data, and a willingness to rethink long
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  standing structures in the pharmacy supply chain.
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  We're at a pivotal moment in health care,
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  and if we design with the consumer in
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  mind, commit to responsible collaboration,
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  and build models that are transparent by default,
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  we can expand access to transformational therapies like
• 13:35
  GLP ones
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  while keeping the system sustainable for everyone.
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  Well, thank you, Bethany, so much for joining
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  us today. It was great to get a
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  bit more context on your collaboration with Eli
• 13:47
  Lilly. And to our listeners, if you'd like
• 13:50
  to listen to more podcasts from Becker's HealthCare,
• 13:52
  you can visit beckershospitalreview.com.
• 13:55
  Bethany, thanks again, and have a nice day.
• 13:58
  Thanks, Liz. You too.