Across the country, employers are watching their pharmacy spend spike, and in many cases, the culprit is the same: GLP-1 medications like Ozempic, Wegovy, and Mounjaro.
These drugs have legitimate clinical value, but without strict clinical management, they can quickly overwhelm a health plan’s budget.
The Cost Surge Is Real
Do you know how much of your Rx spend is from GLP-1s?
We’ve seen it firsthand, the use and cost of GLP-1s doubling, even tripling, often without a clear strategy behind prescribing or monitoring them. These drugs were designed for specific metabolic and diabetic conditions, but in the absence of strong utilization controls, they’re being used far beyond that intent.
If you don’t have a defined process for reviewing, monitoring, and managing these prescriptions, you don’t have cost control. You have open exposure.
Quick Fixes Aren’t the Answer
There’s a new “strategy” circulating in the market: use health reimbursement accounts to have members buy the drugs directly from the manufacturer, then get reimbursed by the employer.
It sounds innovative, but here’s what’s really happening:
- It introduces compliance and legal risk for employers.
- It provides no clinical oversight to ensure the drugs are prescribed appropriately.
- It often creates a poor member experience.
Without clinical management, utilization will rise and costs will follow. Even with added coaching or lifestyle support, these programs fail without a firm clinical foundation.
Our Approach: Proactive, Clinically Driven, and Transparent
At DisclosedRx, we believe responsible management of GLP-1s requires three things:
- Strict clinical oversight to ensure appropriate use.
- Fully disclosed pricing that avoids rebate-driven incentives.
- Education and engagement for members who truly need these medications.
This isn’t about denying care. It’s about protecting plan resources and ensuring that members who need these drugs can continue to access them long term.
When a PBM fails to apply clinical guardrails, it’s not just a financial problem, it’s a fiduciary one.
Ask Yourself
- Has your GLP-1 spend doubled, tripled, or even quadrupled this year?
- Do you know how pervasive these prescriptions are in your pharmacy claims?
- Does your PBM have clear, documented clinical criteria for GLP-1 use?
As GLP-1 use continues to expand, every employer will need a plan for sustainability. The organizations that put strong clinical management in place today will be the ones best prepared for tomorrow’s pharmacy trends.