Latest / On Point with Navion / GLP-1s: Rising Spend, DTC Pressure, and the Coverage Decision

Transcript

GLP-1s: Rising Spend, DTC Pressure, and the Coverage Decision · On Point with Navion

• 0:00
  Welcome to On Point with Navion in
• 0:02
  five minutes or less, we'll break
• 0:03
  down what's happening, what it means
• 0:05
  for your groups, and what to do next.
• 0:07
  No fluff, just what you
• 0:09
  need to know this month.
• 0:10
  Let's get into it
• 0:11
  This month, we're talking about GLP-1s.
• 0:14
  Now, as everyone's aware, the spend
• 0:16
  in this category continues to go up.
• 0:19
  There's a number of reasons why that is
• 0:20
  happening, but a few that we're gonna
• 0:22
  touch on today are indications for this
• 0:25
  continue to be approved by the FDA.
• 0:27
  And so these drugs aren't just
• 0:29
  staying in the type two diabetes
• 0:31
  and weight loss category anymore.
• 0:34
  Approved uses for these drugs are now
• 0:36
  open to lowering cardiovascular risk,
• 0:39
  obstructive sleep apnea, chronic kidney
• 0:42
  disease, and fatty liver disease.
• 0:44
  And the research pipeline doesn't
• 0:45
  stop there, with GLP-1s now being
• 0:48
  studied for osteoarthritis, substance
• 0:51
  use disorder, hypertension, and more.
• 0:54
  Every single one of those is a new
• 0:56
  population of members that may not
• 0:58
  be on a drug today, so the cost for
• 1:00
  these drugs is gonna continue to go up.
• 1:03
  Even if a group's utilization
• 1:04
  looks like it's manageable,
• 1:06
  the trajectory is going up.
• 1:09
  The second thing that's happening is
• 1:10
  there's direct-to-consumer pricing out
• 1:12
  there in the market through avenues
• 1:14
  like Mark Cuban Cost Plus, TrumpRx.gov,
• 1:18
  that are allowing members to fill
• 1:19
  these drugs at lower cash prices.
• 1:22
  That sounds like good news, but the,
• 1:24
  problem with that is these drugs
• 1:26
  are not integrated into the PBM.
• 1:29
  So employers are faced with a hard
• 1:30
  decision because members see these
• 1:33
  drugs that are at a lower cost
• 1:34
  outside of it, but there's no way
• 1:35
  for it to flow through the PBM,
• 1:37
  so it doesn't impact accumulators.
• 1:40
  How you help these employees
• 1:42
  access lower costs,, drugs that sit
• 1:44
  outside your plan is something that
• 1:45
  employers are gonna have to answer.
• 1:47
  So most employers have made peace
• 1:48
  with covering GLP-1s for type 2
• 1:50
  diabetes, but where they're stuck
• 1:52
  is everything outside of that.
• 1:54
  And there's real evidence that shows
• 1:55
  that covering GLP-1s does slow down
• 1:59
  medical cost growth, but the ROI
• 2:01
  isn't there yet because the pharmacy
• 2:03
  spend is still outpacing the medical.
• 2:05
  And so what employers are faced
• 2:07
  with today is, do we cover anything
• 2:09
  outside of type 2 diabetes?
• 2:11
  And what does that leave for them?,
• 2:13
  With the average employee staying on
• 2:14
  the plan only two to four years, if they
• 2:17
  cover those medications now, the ROI is
• 2:21
  likely not gonna be there, because if the
• 2:22
  employee leaves the plan in year six when
• 2:25
  they're working for somebody else, that
• 2:27
  employer is gonna get the benefit of what
• 2:29
  they paid today for the cost of the drug
• 2:31
  So here's where this leaves your groups.
• 2:33
  A blanket yes is expensive, and again,
• 2:36
  the ROI is not there yet to justify it.
• 2:39
  And a blanket no is getting harder
• 2:41
  to defend as employees are looking
• 2:44
  more closely at their employee
• 2:45
  benefits when choosing their next
• 2:47
  employer., So employers are having
• 2:49
  to use this as a recruitment strategy
• 2:52
  to attract and retain top talent
• 2:53
  Now that renewals are coming up,
• 2:55
  there's two things that I would do,
• 2:57
  first, I would pull the GLP-1 numbers
• 2:59
  for your groups, not just looking at
• 3:01
  this year's data, but also looking at
• 3:03
  the last few years of data and comparing
• 3:06
  what the cost and the trend is for those
• 3:08
  medications., Who is new on the plan?
• 3:11
  Who is new to these types of
• 3:12
  medications, and where do you think
• 3:15
  you're gonna decide to land on
• 3:16
  coverage outside of type 2 diabetes?
• 3:19
  Does it make sense for you to
• 3:21
  cover weight management or look at
• 3:23
  coverage for obstructive sleep apnea?
• 3:25
  There isn't a right answer for that,
• 3:27
  but every group is gonna have to make
• 3:29
  that decision based off their strategy.
• 3:32
  And second, I would look at what
• 3:34
  your PBM strategy is regarding
• 3:37
  criteria for, clinical management.
• 3:40
  Every PBM has different criteria for
• 3:42
  this, so there's options to put in
• 3:45
  stricter utilization management practice
• 3:49
  or looser utilization management
• 3:52
  practices., And again, it's not a
• 3:54
  one-size-fits-all approach, but based
• 3:57
  off your strategy for employee benefits
• 3:59
  and what you wanna do to help your
• 4:00
  members get access to these drugs, have a
• 4:02
  conversation about that and see what the
• 4:05
  right option is for you moving forward
• 4:07
  thank you for watching
• 4:07
  On Point with Navion.
• 4:09
  This was part one of two of the GLP-1
• 4:12
  episode, and we'll see you next month