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

Transcript

Rethinking GLP 1 Coverage Through Transparent, Consumer First Pharmacy Models · Becker’s Payer Issues 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.
• 0:16
  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
• 0:29
  upper right. We're looking forward to hosting you
• 0:31
  here in Chicago.
• 0:33
  Hello, everyone. This is Elizabeth Cassello with the
• 0:36
  Becker's Payer Issues podcast.
• 0:38
  I'm thrilled today to be joined by Bethany
• 0:41
  Stein, segment president of pharmacy at Humana.
• 0:44
  Bethany, thanks so much for chatting with us
• 0:46
  today. Yeah. Happy to be here. Thanks for
• 0:48
  having us, Liz.
• 0:49
  Yeah. So before we jump into the conversation,
• 0:52
  can you tell us a little bit more
• 0:54
  about yourself, your health care career background,
• 0:57
  and what your role is at Humana?
• 0:59
  Yeah. Happy to do that.
• 1:01
  Bethany Stein, as Liz said, president of Humana's
• 1:04
  pharmacy segment, CenterWell Pharmacy. I am a pharmacist
• 1:08
  by trade,
• 1:10
  and started at Humana right out of pharmacy
• 1:12
  school as a resident.
• 1:14
  So today, I oversee the strategic growth operations
• 1:17
  and p and l of Humana's three different
• 1:20
  pharmacy businesses, which include
• 1:22
  CenterWell Pharmacy, our home delivery pharmacy,
• 1:24
  CenterWell Specialty Pharmacy, and then Humana Pharmacy Solutions.
• 1:29
  And I would just add that my team's
• 1:31
  focus is incredibly simple. Right? We wanna make
• 1:34
  pharmacy more transparent, more consumer friendly,
• 1:37
  and more clinically effective at scale.
• 1:41
  That's great to hear, Bethany, and thanks again
• 1:43
  for joining us.
• 1:44
  So the big news I wanna talk about
• 1:46
  today is how Humana Centerwell Pharmacy is going
• 1:49
  to dispense Eli Lilly obesity management drugs
• 1:52
  through its employer plan sponsored carve out programs.
• 1:56
  What are employers asking for right now when
• 1:58
  it comes to GLP one coverage, and how
• 2:00
  does this partnership
• 2:02
  enable Humana to respond to that demand?
• 2:05
  Yeah. Thanks, Liz. I love this question. I
• 2:07
  think employers are in a very different place
• 2:09
  with GLP one coverage today than even a
• 2:12
  year ago.
• 2:13
  The conversation has essentially shifted from should we
• 2:16
  cover them to how we cover them responsibly.
• 2:20
  They're looking for predictability,
• 2:21
  control, and transparency,
• 2:24
  but without
• 2:25
  restricting access for the people who truly need
• 2:27
  these medications.
• 2:29
  So what we're hearing consistently from employers is
• 2:31
  that not all GLP one use is the
• 2:34
  same.
• 2:35
  Right? So different employee populations
• 2:37
  have very different clinical needs, whether that's dose
• 2:40
  escalation,
• 2:41
  duration of therapy,
• 2:42
  or just like the type of behavioral support
• 2:44
  required to be successful.
• 2:47
  So employers
• 2:48
  are increasingly asking for benefit designs that stratify
• 2:52
  populations
• 2:53
  thoughtfully,
• 2:54
  rather than treating GLP ones as one large
• 2:57
  undefined cost category.
• 2:59
  So for example,
• 3:01
  some programs that distinguish between
• 3:03
  high risk metabolic patients that may see the
• 3:05
  greatest downstream medical savings. Right? A weight only
• 3:09
  population
• 3:10
  where employers may want more guardrails and accountability.
• 3:14
  And then finally, maintenance versus initiation phases where
• 3:18
  intensity and cost can differ significantly.
• 3:21
  So that kind of segmentation
• 3:23
  helps employers move from this broad utilization
• 3:26
  concern
• 3:27
  to an intentional strategy where they can support
• 3:30
  the right patients without runaway spends.
• 3:34
  And, honestly, Liz, like, the cost pressures are
• 3:36
  real. Right? A recent Gallagher study showed that
• 3:39
  GLP one drug class spend increased 35%
• 3:42
  in 2024
• 3:44
  and another 25%
• 3:45
  in 2025.
• 3:46
  So even with good clinical outcomes, that cost
• 3:50
  trajectory is truly outpacing
• 3:52
  the near term medical savings.
• 3:54
  So employers are rethinking their models and leaning
• 3:57
  into approaches that give them clear line of
• 3:59
  sight to both utilization
• 4:01
  and value.
• 4:03
  And so, again, going back to
• 4:05
  integrating segmentation,
• 4:07
  clinical oversight,
• 4:08
  and a more transparent pharmacy model, we at
• 4:11
  CenterWell are really helping employer structure GLP one
• 4:14
  benefits
• 4:16
  in a way that meets the moment,
• 4:18
  sustainable,
• 4:18
  intentional,
• 4:20
  and still high quality for their members. So,
• 4:22
  ultimately, it's about giving employers the confidence that
• 4:25
  they can offer these important therapies without sacrificing
• 4:29
  affordability
• 4:30
  and giving employees
• 4:31
  a support model that actually helps them succeed.
• 4:34
  So I would just say that is in
• 4:35
  general why we are so excited
• 4:37
  with where we're going in our partnership with
• 4:40
  Lilly and other various partners within this ecosystem.
• 4:44
  Yeah. So I was actually going to ask
• 4:45
  about those other partners just to give context
• 4:48
  to our listeners.
• 4:49
  Humana is also working with Novo Nordisk on
• 4:52
  direct to patient, we go via access.
• 4:54
  And there's also just beyond that, some recent
• 4:57
  research points to slowed medical cost growth for
• 4:59
  g l p GLP one users in the
• 5:01
  long term.
• 5:03
  So how do those collaborations
• 5:05
  with manufacturers
• 5:06
  so Eli Lilly, like what we're talking about
• 5:08
  today, Novo Nordisk,
• 5:10
  work together to bend that cost curve without
• 5:12
  restricting access? Just elaborating a little bit more
• 5:14
  on those stratification points that you mentioned earlier.
• 5:18
  Yeah. I would just say, I think GLP
• 5:20
  ones are both clinically transformational
• 5:23
  and financially challenging at scale. Right? And so
• 5:26
  that's exactly why we're talking about such a
• 5:29
  deliberate approach.
• 5:30
  So Humana
• 5:32
  is building a consumer focused health care company,
• 5:34
  and pharmacy is a strong expression of just
• 5:37
  that strategy.
• 5:39
  Whereas CenterWell Pharmacy, just as as background information
• 5:42
  for you all, is was built originally for
• 5:45
  the health plan by the health plan. So
• 5:48
  from day one,
• 5:50
  it has been designed around outcomes,
• 5:53
  transparency, and affordability,
• 5:54
  not spread pricing, rebate fees, or intermediaries.
• 5:58
  And so we have results that really speak
• 6:00
  for themselves in the form of better outcomes.
• 6:03
  Right? CenterWell patients have
• 6:05
  15% fewer ER visits and 13%
• 6:09
  lower hospitalizations
• 6:10
  than patients using any other pharmacy in our
• 6:12
  network, and we validate that annually.
• 6:15
  We see better experience.
• 6:16
  Right? Our net promoter score is consistently 15
• 6:20
  points higher than other pharmacies.
• 6:22
  We we deliver that true transparency. Right? So
• 6:25
  for thirty years, we've operated with no hidden
• 6:28
  fees, no gains, and complete visibility for the
• 6:30
  health plan.
• 6:32
  And then lastly, affordability
• 6:33
  is just built into our model. Right?
• 6:36
  At at the highest level, 90% of our
• 6:38
  generics cost less than $2 a month, many
• 6:40
  with no co pay at all.
• 6:42
  And we truly proactively
• 6:44
  help members find lower cost alternatives
• 6:46
  and financial assistance for high cost brands and
• 6:49
  specialty drugs.
• 6:50
  So when you combine all that
• 6:53
  with home delivery
• 6:54
  scale and a consumer first mindset,
• 6:57
  you really end up with a pharmacy model
• 6:59
  that is uniquely aligned to what the GLP
• 7:02
  one marketplace requires,
• 7:04
  predictable pricing and clinical integrity.
• 7:07
  And so that's why we're expanding this model
• 7:10
  beyond Humana members to a direct to patient
• 7:13
  pharmacy solution model for GLP ones. And so
• 7:16
  to get to your question,
• 7:18
  our collaborations with manufacturers like Novo Nordisk and
• 7:21
  Eli Lilly are built upon those same principles.
• 7:24
  We just simplified access at a lower out
• 7:27
  of pocket cost. And so this truly does
• 7:30
  bend the cost curve and expand access,
• 7:33
  and we're doing it
• 7:34
  exactly how a consumer health care company should
• 7:37
  do it. Right? Simplifying the ecosystem,
• 7:40
  removing friction and waste,
• 7:42
  delivering predictable transparent pricing,
• 7:45
  improving outcomes and adherence,
• 7:46
  and scaling safely and responsibly.
• 7:49
  So we're not restricting access. We're expanding safe,
• 7:53
  affordable, high quality access
• 7:55
  while building a cost structure that is sustainable
• 7:58
  for payers, employers, and consumers over the long
• 8:01
  term.
• 8:02
  And I believe that this is really the
• 8:05
  future of pharmacy care. Right? A consumer centric,
• 8:08
  clinically guided, transparent,
• 8:11
  and and it's built to support the next
• 8:13
  generation of therapies at scale.
• 8:16
  So I actually wanted to ask a little
• 8:18
  bit about that adherence point because that is
• 8:20
  such a concern here.
• 8:22
  What
• 8:23
  steps is Humana taking while they're working
• 8:26
  with employers
• 8:28
  on promoting adherence?
• 8:30
  And what what else do you have to
• 8:32
  say on adherence?
• 8:33
  Because that is just such a big concern
• 8:35
  in terms of the cost here.
• 8:37
  Yeah. I totally agree. And if you if
• 8:39
  you taking a step back, I would say
• 8:41
  the strongest support around medication adherence
• 8:44
  is a lot of the clinical programs and
• 8:46
  support elements that we have in place today.
• 8:49
  So just another metric for you. At CenterWell
• 8:52
  Pharmacy, we see about 260 basis points better
• 8:56
  medication adherence than we see in other pharmacies
• 8:58
  in our network. And so our pharmacy is
• 9:01
  truly incentivized
• 9:02
  to to focus on adherence because we know
• 9:06
  there is a ton of downstream clinical impacts
• 9:10
  related to that. The hospitalizations
• 9:12
  I mentioned, the ER visits,
• 9:14
  those are all
• 9:15
  lowered, and this is well studied in the
• 9:17
  industry, when patients take their medicines.
• 9:21
  Right? And so I would say at CenterWell
• 9:23
  Pharmacy, we have
• 9:24
  robust medication adherence programs
• 9:27
  that are in all forms, whether it be
• 9:30
  reminder calls or having conversations with pharmacists around
• 9:34
  barriers to adherence.
• 9:36
  We segment the population
• 9:38
  on those that are high risk of falling
• 9:41
  out of medication adherence
• 9:43
  versus ones who we know may just need
• 9:45
  a little bit of a nudge or a
• 9:46
  lower cost intervention.
• 9:48
  So we've done a ton of research on
• 9:49
  this. I would say we have a ton
• 9:51
  of clinical interventions, and I'm really proud of
• 9:54
  the investments that we have made to support
• 9:56
  medication adherence
• 9:58
  because it is a win win solution when
• 10:00
  members take their drugs. We just see the
• 10:02
  better better medical outcomes
• 10:04
  that that result.
• 10:07
  Yeah. Absolutely. And you mentioned this earlier, but
• 10:10
  you think that employees are
• 10:12
  shifting their perspectives on GLP ones at least
• 10:14
  in the past year.
• 10:16
  Could you talk a bit more about why
• 10:18
  now is the time to deepen relationships with
• 10:20
  manufacturers
• 10:21
  offering weight loss drugs?
• 10:23
  Yeah. It's it's a great question.
• 10:25
  The health care system is under pressure to
• 10:28
  lower drug costs and expand access. Right? Creating
• 10:31
  a truly a favorable environment for an alternative
• 10:34
  benefit model. The system does need a new
• 10:37
  model,
• 10:38
  and both manufacturers
• 10:39
  and employers know that they cannot solve this
• 10:42
  alone.
• 10:43
  So the environment,
• 10:44
  I would say, today makes partnerships like ours
• 10:47
  especially valuable
• 10:49
  because they deliver on what the market is
• 10:52
  demanding right now. But just going back, I
• 10:54
  mean, GLP ones were definitely the catalyst, and
• 10:57
  here's why. I mean, one, affordability
• 11:00
  was and still is a top concern for
• 11:02
  regulators and legislators,
• 11:04
  and access to GLP ones
• 11:06
  were declining.
• 11:07
  Two, drug shortages at the time exploded. Right?
• 11:11
  And the market was flooded with compounds and
• 11:13
  non FDA approved alternatives,
• 11:15
  creating real safety risks.
• 11:18
  Three,
• 11:19
  manufacturers were looking for a way to disrupt,
• 11:22
  and we became that partner.
• 11:24
  Starting with our partnership last year with Novo
• 11:26
  Nordisk for Wegovy,
• 11:28
  and now with Eli Lilly.
• 11:30
  Together, we've lowered costs, helped patients avoid unsafe
• 11:33
  alternatives, and addressed barriers to access and affordability.
• 11:38
  And I wanted to hear some final thoughts
• 11:40
  and advice as we wrap up for other
• 11:42
  industry leaders. And I know
• 11:44
  you mentioned a lot about what CenterWell does
• 11:47
  really well, but what advice do you have
• 11:48
  also for payers that might not have a
• 11:51
  pharmacy component
• 11:52
  and what they could be thinking about right
• 11:54
  now?
• 11:56
  Yeah. If there were
• 11:57
  if there's one takeaway from our experience, it's
• 12:00
  this. The GLP one moment isn't just about
• 12:03
  GLP ones. It's about rethinking the entire ecosystem
• 12:08
  around access, access, affordability, and consumer experience.
• 12:11
  My advice is simple. Right? Start designing
• 12:15
  for the consumer first. When you build models
• 12:18
  that prioritize
• 12:19
  transparency,
• 12:20
  clinical quality, and predictable cost, you don't just
• 12:24
  improve access. You naturally bend the cost curve
• 12:27
  because the system becomes simpler.
• 12:31
  Second, leaning into partnerships. None of this none
• 12:34
  of us can solve the drug affordability and
• 12:36
  access challenge alone.
• 12:38
  Manufacturers,
• 12:39
  pharmacies,
• 12:40
  payers, and employers
• 12:42
  each control a different lever. So when those
• 12:45
  work together, like our collaborations with Eli Lilly
• 12:48
  and Novo Nordisk, you can really create access
• 12:50
  channels that are clinically responsible,
• 12:53
  financially sustainable, and scalable.
• 12:56
  And then just finally,
• 12:58
  embracing transparency and data.
• 13:00
  The organizations
• 13:01
  that win in this space will be the
• 13:03
  ones who can demonstrate real outcomes,
• 13:06
  drive medication adherence,
• 13:08
  and give payers and employers true line of
• 13:11
  sight into utilization and value.
• 13:13
  So that obviously requires openness,
• 13:16
  shared data, and a willingness to rethink long
• 13:19
  standing structures in the pharmacy supply chain.
• 13:22
  We're at a pivotal moment in health care,
• 13:24
  and if we design with the consumer in
• 13:26
  mind, commit to responsible collaboration,
• 13:29
  and build models that are transparent by default,
• 13:31
  we can expand access to transformational therapies like
• 13:35
  GLP ones
• 13:36
  while keeping the system sustainable for everyone.
• 13:40
  Well, thank you, Bethany, so much for joining
• 13:43
  us today. It was great to get a
• 13:44
  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.