GLP-1’s Cardiometabolic Benefit and the Impact on Coverage

This past May, Pharmaceutical Executive reported that CVS Health decided to return Eli Lilly’s Zepbound to its list of covered medications, along with the addition of the company’s new oral GLP-1 Foundayo. CVS previously removed Zepbound from its formularies due to pricing negotiations with Lilly’s competitor Novo Nordisk.

This story is just the latest example in the ongoing issues GLP-1s face when it comes to coverage. While the drugs are known to be effective and safe, they are also in high demand and effective. As a result, coverage providers have struggled to include the medications, especially considering the wide swath of indications they can be prescribed for.

One area that’s been of particular interest is employer coverage. Companies want to be able to promote that their employees are covered for these in-demand drugs, but they also must consider other factors.

Pharmaceutical Executive spoke with Susan Thomas, chief commercial officer at LucyRx, about the company’s efforts to provide coverage models for GLP-1s and why its so important to provide these medications for general health purposes.

Pharmaceutical Executive: What impact has research into the cardiometabolic benefit of GLP-1s had on coverage?
Susan Thomas: Investment in GLP-1s is certainly a cost consideration. The longer-term benefit of improving cardiovascular risk is a longer journey. As a plan sponsor, you may not see immediate savings on medical costs, reductions in heart attacks, strokes, and those kinds of events right away. But when you commit to the long-term benefit, that's when you'll see those cost savings materialize.

Plan sponsors often focus on the immediate cost implication rather than the long-term return, and that's why GLP-1 coverage has become a budget line item rather than a strategy for serving a population over the long haul.