How Has the Rise of GLP-1s Impacted Businesses Outside of Pharma?

Pharmaceutical Executive: How has the rise of GLP-1s impacted businesses outside of pharma?
Jay Bregman: Up until, the rise of these medications has been severely negative for businesses. It’s been an incredible amount of cost and operational complexity. How do we add step therapy, barriers, and prior authorizations to manage the utilization of these drugs. Ultimately, for a lot of businesses in the coming years, the question is how to get off the financial burden of these drugs before it cracks the overstretch pharmacy and medical budgets.

Businesses want to be available to provide for employees and be competitive. They want workers to be able to go to the HR department and ask about GLP-1 coverage and get a good answer. Up until now, the answer was it depends or sorry. Those aren’t good answers for a drug that half the population wants or needs.

PE: How do new GLP-1 drugs impact businesses' ability to provide them to employees?
Bregman: Unfortunately, the new options just amplify the problem. At least until 2027, those options still come from the same two companies that have already been providing these medications, Novo Nordisk and Elil Lilly. There is a dynamic where they’re coming out with new treatment options, but the issue is that these create more demand. The indications for these drugs continue to increase.

Pretty soon, there could be a whole basket of things could apply to 70% of the population. It could be the case that in a couple of years, everyone in America that’s an adult is indicated to these medications. The more innovations and studies, the more people want them. That creates a bigger problem for businesses. Even if they were to cover them, they’ll have to cover them for so many more people that it brings them back to square one.

PE: How will the inclusion of GLP-1s in Medicaid and Medicare impact businesses?
Bregman: The government is basically a giant insurance company, so it has the same (if not worse) problems as anybody else. It has to give out drugs to a population and how do they afford to give every person in the country access to medication on this scale. The answer is that they can’t. Look at what’s going on in the NHS or any other European system. They give out less of these medications than anyone else. Most of the prescriptions for GLP-1s are being written by private sources.

If you look closely at the criteria that Medicare is going to use to give out these medications, it’s not that different than what it was. Today, you could get on GLP-1s for heart conditions or diabetes, they’ve just added obesity. The criteria is going to massively restrictive because the government can’t afford to give it to everybody. I don’t expect Medicare to have a massive impact on the overall picture.