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The GLP-1 Revolution: Taming the Wild West of Weight Loss Medications
The numbers tell the story: $700,000 saved for a single client. GLP-1s now represent 25% of our total pharmacy spend. Our team denies over 50% of all prior authorization requests for GLP-1 medications.
Few categories of prescription drugs have captured as much attention in recent years as GLP-1 agonists. Medications like Ozempic and Mounjaro have surged in popularity. This surge is not just for their role in helping people with Type 2 Diabetes (T2D), but also for potential off-label use in weight management. This surge in demand has put pressure on payers and plan sponsors to manage costs while ensuring that patients who truly need these treatments can access them.
At Serve You Rx, we take great pride in being proactive stewards of our clients’ pharmacy spend. Today, GLP-1 therapies account for nearly 25% of total client costs in our book of business. Yet, thanks to utilization management programs and oversight, we help our clients control budgets and maintain quality member outcomes.
Balancing Access with Appropriate Use
A key component of our strategy is ensuring that GLP-1 prescriptions are used for FDA-approved indications. Our 2024 data show that we approved less than half of all prior authorization (PA) requests for T2D GLP-1 medications. This result highlights the extensive scope of off-label prescribing in this area and serves as a testament to the diligence of our clinical team in ensuring that FDA guidelines are properly followed.
Most frequently, these denials were because the medication was being prescribed for off-label use (often pre-diabetes or weight loss for a non-weight loss drug). These denials keep costs in check and ensure patients who need GLP-1 agonists to manage T2D have reliable access.
The same principle applies to obesity-specific GLP-1 medications, such as Wegovy, ZepBound, and Saxenda. Our rigorous PA processes and collaboration with prescribers have led to a balanced distribution of approvals and denials for these therapies. This balance again reflects the careful stewardship of our clients’ resources.
Consider this real-world impact: One client had 64 unique members who were denied a GLP-1 used for obesity because the member did not actually have obesity. This saved the client over $700,000 annually by ensuring the member was using the medication for an FDA-approved indication.
Staying Ahead of the Curve with Real-Time Data and Adaptation
Being a good steward means staying attuned to trends and adjusting quickly. Our internal data on both Type 2 Diabetes GLP-1s and obesity-focused GLP-1s helps us identify real-time prescribing habits. This way, we can respond to off-label usage and adapt our strategies. For example, as new indications or new products (such as ZepBound) enter the market, our team continually revises coverage criteria to capture the latest evidence and help clients stay ahead of the curve.
Stronger Together: Serve You Rx and Our Clients
We understand that the rising popularity of GLP-1 therapies can feel daunting for employers and plan sponsors. But our experience has shown that a structured, evidence-based approach helps manage costs without compromising member health. We actively engage with our clients to provide education on appropriate use, ensure robust PA criteria for new and existing medications, and track outcomes to confirm that our approach delivers positive results.
Ultimately, our mission is to help our clients support their members’ health responsibly and cost-consciously. With nearly a quarter of our clients’ overall pharmacy spend now going toward GLP-1s, vigilance and proactive policies have never been more important.
Looking Ahead
The future of GLP-1 therapies will require continued diligence. As research reveals more diseases positively affected by reductions in patient weight, we expect GLP-1 utilization to continue its upward trajectory.
The pipeline continues to expand, with new drugs in Phase 2 and Phase 3 clinical trials from manufacturers such as Eli Lilly, Novo Nordisk, Amgen, and Pfizer on the horizon. These include promising formulations, such as once-daily oral tablets.
Now is the time to prepare for the continued surge in member interest and demand.
Our team is prepared to adapt to evolving clinical evidence, new product launches, and changing regulations. We will ensure our clients stay ahead of the curve. We see it as our responsibility to foster the highest possible value for every pharmacy dollar spent.
As GLP-1 medications continue to grow in popularity, our evidence-based approach to utilization management provides a clear path forward. As demand increases, our commitment to striking a balance between appropriate access and cost management remains our guiding principle.
Do you have clients who need better GLP-1 controls and oversight?
Serve You Rx is here to help.
About Serve You Rx®
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what's best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for nearly 40 years, Serve You Rx can implement new groups in 30 days or less and say "yes" to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.
