Balancing Cost and Care With GLP-1 Employee Benefits

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Monique: What began as breakthrough treatment is quickly becoming a bigger conversation for HR teams everywhere. GLP-1 medications, once primarily used to treat diabetes, are now reshaping the conversation around weight management, employee well-being, and the future of health benefits. But with skyrocketing demand comes complex decisions about cost, access, and long-term value.

Welcome to Honest HR, where we turn real issues facing today's HR departments into honest conversations with actionable insights. I'm your host, Monique Akanbi. Let's get honest For HR leaders, GLP-1 medications have moved from healthcare trends to business challenges, one that sits at the intersection of employee expectations, financial sustainability, and strategic workforce planning.

Joining us to help break down the complex realities of this benefit and 15 years of pharmacy benefit consulting expertise is Ginny Crisp, CEO of Prescription Benefit Solutions. Welcome to Honest HR, Ginny.

Ginny Crisp: Thank you. I'm happy to be here. Thanks for having me.

Monique: We are excited to talk about a topic. I don't think there's any conversation that I'm in, whether at work or just personally, where GLP-1 is not brought up, right?

Ginny Crisp: Absolutely. That's definitely happened for me as well with most of the clients. That is the number one topic they want to talk about when we meet.

Monique: Yes. So I am excited to dig into this topic. First, can you start by explaining why GLP-1 medications have become such a hot topic in employee health benefits?

Ginny Crisp: Yeah, absolutely. That's a great question. I think it really comes down to the convergence of several things that have happened recently. One being that for the first time, we have a treatment that works for obesity, which is something that prior to this has not really been available, and it's worked better than anything else.

Secondly, we've had a lot of new indications, which are approvals for the treatment of other things outside of diabetes and obesity for these medications, so the uses are just expanding. It feels like on a daily basis, even though I know that's not technically true, it takes a while to get that, but they're definitely growing.

Another big piece to it is the fact that the social media campaigns and awareness that has really brought this to the forefront, I think started a few years back with celebrities who were sharing their own personal stories and journeys and influencers, and that was way more impactful than the direct-to-consumer advertising that any pharmaceutical company had tried to do in the past. So that was very effective.

But I think the fourth thing is the workforce itself just has such a high rate of individuals that have been touched by obesity, so that's at least 40% of the workforce based on just their BMI alone, or body mass index, could qualify for having one of these products.

So all of that coming together has really set the landscape for these discussions, and I think it's a permanent shift in how we're going to be looking at this and not just thinking about obesity as one piece, but really packaging this up for multiple different things that we're going to address.

Monique: Yeah. I think about just having a healthy employee, and if there is a benefit that is available that employers can offer, considering cost as well, but that they can offer to ensure that their employees are healthy, then that directly translates to productivity and positive business outcomes.

So I can definitely see this transition happening where it is more of a discussion around offering that as a benefit. According to 2025 SHRM Benefit Survey, less than a quarter of employers offered GLP-1 drug coverage. For HR teams who are just starting to explore GLP-1 coverage within their employee benefits programs, what are some critical factors that they should consider?

Ginny Crisp: That's also a good question. One thing that I'll clarify, and I try to do this a lot when we're having these conversations with clients, is that they've been covering GLP-1s for a long time for diabetes, so that's not new. What's new and what's kind of come to the forefront, which is part of the decision-making process, is really around whether they're going to extend that coverage to weight loss, right?

So, that's been kind of always this lifestyle option. They didn't have to do it, and that's the way it has always been handled in the past. So, it's really about how do you cover weight loss if that's something that you want to do.

And so, the very first thing that I encourage the groups that I work with to think about is what PBM partner do they have? Because all the strategies that are important to consider for designing a benefit around that are only effective if the partner you work with allows you to do any of them. So, if they're not going to allow custom co-pays or designing the benefit the way you want to, then you're really stuck with whatever their standard coverage is, right?

So, I think the first thing is to just figure out what type of partner do you have. Are they flexible at all? And then if they are, really needing to put some guardrails around how you want this to move forward.

And I really can't stress the importance of really looking at a total package. So, not just coverage of the drug, but incorporating lifestyle modifications into it, because one of the things that's left out of especially the media coverage, is that all of the studies that put these drugs forward for approval had a lifestyle intervention in both the placebo group and the treatment arm.

So, the success rate of that weight loss, and that sustained weight loss, is really with pairing it with a drug, having that lifestyle. So, I would encourage any of these listeners that are thinking about building this out to really look at that. Can you do lifestyle as part of it, so that you're really aligning yourself as close as you can to the way that the studies were, which showed that success with that weight loss.

But again, it all frames around the PBM and whether they're willing to partner with you on that, and be flexible and offer you some consulting on the best way to do this, to not limit access for your members, but to also stay financially responsible.

Monique: Yeah. And just to clarify, when you say PBM, you mean pharmacy benefit manager?

Ginny Crisp: Managers, right. So yeah, all the self-funded plans out there are going to have a medical vendor and a pharmacy vendor, and the pharmacy benefit manager is the one that's going to manage the benefit based on how they set it up, what drugs are available, what steps are required to get access to those drugs, and things like that.

So they really are the ones that are going to set up the access to it if you decide to turn it on.

Monique: Got it. I have to tap into my benefits broker world. I used to do HR for an employee benefits broker, so I think I remember PBM.

Ginny Crisp: Right. And I forget sometimes in my world every day that's what I'm there for, is to talk about their PBMs. So most of them at least know a little bit about that, but that's a good distinction.

Monique: Yeah. No, absolutely. And I love that you called out not just focusing on the drug, but then also complementing that with maybe some other lifestyle benefits so that way it's not just the drug alone, right? But it's a change in your diet, maybe being a little more active. So really considering other factors outside of just the drug when offering it to employees as a benefit.

What are the key financial challenges employers face when deciding whether to include GLP-1 in their health benefit plans?

Ginny Crisp: Yeah. I would like to say that this challenge has gotten easier over the years, but it really hasn't. I think that there's several things that go into it. The first is that the eligible population tends to explode. Like, once you decide to do this, I think a lot of employers that have forecasted this and they think they know what the cost is going to be, and then they turn it on, they're really surprised with the uptake of it.

Now, this has only been going on for two, three years, right? So this isn't like we have 10 years plus of information on what that trend will look like. So I do think some of that plateaus a little bit, but we're not quite there to see that. So it's really hard to know what your total population's going to look like that may take advantage of the benefit.

Then utilization's difficult, too, because there are a lot of studies showing what I call quit rates, but they call it persistence rate. So how long will an individual stay on that medication, right? And I think this is one of those areas where you're not considering coverage for something that's acute, like an antibiotic, where you can take it for a short term, you're done with it.

We really don't have the long-term studies to show exactly what needs to happen and when people need to try to taper off of the therapy if possible. But again, that really can't happen if you're not doing lifestyle modifications, because what we do know is if they stop it abruptly, they're going to have weight gain that comes back quicker than they were able to lose it.

So all of that goes into the complex picture of what is this going to cost, and not knowing the utilizers, not knowing how long this therapy could go on, and how big your population pool even is, I think is what goes into the financial challenges with them trying to model that out for leadership.

Monique: We'll be back in just a few moments. Stay with us.

Monique: You mentioned partnering with the pharmacy benefit manager. And pharmacy benefit managers are critical partners in managing that cost and also the accessibility of the prescription medications. How can HR professionals ensure that their PBM contracts are structured to manage the cost of GLP-1s effectively?

Ginny Crisp: Yeah. So, I could have a whole podcast on partnerships and contracting with PBMs, but what I will say in general is that the cost is already expensive. We all know this, right? So you want to have a contract that's set up where you're paying the actual cost of that medication.

PBMs are allowed to have contracts where you're not paying that pass-through amount, meaning that they could pay the pharmacy one price for that GLP-1 prescription, but then turn around and invoice you a very different amount, which is going to be higher, and they keep that difference. And in our industry, that's called spread pricing, which costs you more money than you would need to pay on those medications. And not just for GLP-1s, but for everything.

So I think the first question is what type of drug pricing contract do you have, to ensure that you're getting pass-through pricing?

The second thing kind of related to that, but different, is the rebates. So I am not a rebate chaser. I want to put that out there on the front end. But what I do know is that for obesity medications, there are no generic options, so these brand medications are necessary, and with that are going to come rebates.

It's a broken system, but it's what we have today, right? So what I want to make sure that the client isn't having the rebates either not provided to them at 100%, so the PBM's keeping some of it, they're not giving them any of it. So the rebate question's really important because it can bring down the cost by 40% to 50% based on that sticker price if they have a really good rebate program in place.

So that's part of it, ensuring that there is both of those things happening, drug pricing rebates at a pass-through model. The other thing is, as I mentioned around flexibility in doing a lifestyle modification. So this might be shocking since I said that the FDA approved these drugs on having that combination, but a lot of PBMs will tell you that if you add in lifestyle requirements, that they can't or won't do it because it impacts your rebates, and they claw back those rebates.

Well, there's lots of reasons that that happens, but I think it's very sad that they are not wanting to model what actually was used to have that success. And really investing in that MEMBER's long-term health, which is, I would think, what the employer really wants to do, right? It's beyond just the weight loss, it's the bigger picture.

So, being able to ensure that that's not going to happen, that you can make some custom alignments with what works for you, but you don't have those rebate impacts. And then reporting is the last piece of it. Are they willing to give you direct access to what the cost was, what your rebates were, what your net cost is, so that you can really evaluate the full impact without going in blind?

Because without that data, it's really hard to really model anything, right? Even if you know the number of people, you're not really able to see what's happening with that because rebates take so long for you to be paid on them. So, I think if you ask those questions and you can't get clear answers, that's when you really have to think about, do you need to consider alternatives and looking in the market for an alignment with a partner that's going to give you all of those things that'll help bring your costs down.

Monique: Oh, wow. That's a wealth of knowledge that you just shared. And it's helpful, right? Because you provided very actionable items and insight as it relates to when partnering with PBMs and things to ask for. Shocking that they'll pull back from when you start incorporating lifestyle benefits to that, and then pulling back on the rebates or cost-sharing or I believe is the term that you used.

But very helpful. How might government policies such as drug pricing reforms or even healthcare mandates affect the accessibility and affordability of GLP-1 for employer-sponsored health plans?

Ginny Crisp: So this is a positive. I think this is probably one of the areas that a lot of us in this industry have been waiting on, is forcing the hand of both the manufacturers and the PBMs in two different ways.

So there's a lot of pressure right now happening in the policy landscape. There are programs that are popping up that are going to bring the cost down, and those are already very closely being monitored, but also they're very new. So most of them have popped up between December and now, where we have this in a couple of buckets.

One is that both of the manufacturers of those medications are offering direct-to-consumer programs, and that's again directly related to the pressure they're getting from the government to decrease the cost. And then there's also direct-to-employer programs, which is also in response to that.

That's all bundled into the Medicare pricing negotiations that have been ongoing. And some of the listeners may say, "Well, Medicare doesn't really impact what I do. We're more on that commercial side," which is true. But historically, when the commercial side gets benefit from those Medicare pricing points, because eventually it trickles down into the commercial sector.

So I think that pressure that's happening on cost is going to change the story pretty significantly in the coming months. In addition to that, the FTC or the Federal Trade Commission is really applying a lot of pressure on PBMs to be more transparent with both their drug pricing and the rebates.

And so there's a huge shift for the first time in years really around trying to bring forth some transparency around it, and all of that is going to be beneficial to both the members and the employers as the cost comes down.

Monique: Wow. And speaking of or in line with transparency, how should HR professionals or how can the HR professionals effectively communicate, one, the value, but two, also the limitations of GLP-1 coverage to employers and employees?

Ginny Crisp: Yeah. So, transparency is key, right? You build trust on both sides of that. So if you're trying to talk about this with leadership and you're very forthcoming about all the major points around the GLP-1s, that's going to gain traction with leadership. But conversely, with the employees, it's super important to be upfront about that as well.

So I think about it as two things. With leadership, they need to understand the optics of employees right now. So there are studies that have come out to say that about a third of employees would consider moving jobs if they could get GLP-1 coverage.

Monique: Wow.

Ginny Crisp: That's a huge population, right? It's 30%. So if I'm a leader or an owner, which I am, of a company, and I hear that I want to keep my good people, right? So that's going to be information that I need to know.

But on the flip side of that, it also needs to be shared with me that this isn't an overnight return of investment, right? So it's going to take a while to show any type of benefit beyond just looking at the cost of the drugs that's going to happen immediately. So them understanding that and what that looks like as you're building the business case is really important to get the right support on the front end so that the program can be successful.

With employees, I think communication is key. Drafting FAQs proactively has been super helpful with a lot of my groups. I've helped them to do that where we have two things, right? So you have the employers that don't cover it, so it's explaining why to the employees it's not being covered, and even more importantly, what options are out there, right?

So that direct-to-consumer program, how can they get access to it? What do the employees need to know about it? But if they are covering it, the employee understanding the criteria and why it's there and what is involved in that program. So if you've turned on any type of lifestyle modification, notifying them on the front end of what that looks like so that they're going into it eyes wide open and know that they're going to start a medication that they can continue to afford and participate in programs that are going to make them successful or not do it at all, right?

And if they don't know that on the front end, they can't make the best decision for themselves.

Monique: We'll be back in just a few moments. Stay with us.

Monique: You mentioned, especially for employers, something to consider is that they may not realize the immediate ROI of offering GLP-1 as a benefit. So in your opinion, how should HR professionals evaluate that ROI coverage of GLP-1 medications beyond just what that upfront cost would be? But then also what is the business imperative?

Ginny Crisp: Yeah. So, this is probably one of the most frustrating parts of my job. As a pharmacist, we tend to be pretty black and white. We like numbers, we like to have things make sense, right? So, when someone asks for that ROI that we really don't have the studies yet for, it's difficult sometimes to have that conversation.

But I think the biggest take-home that I always share is the industry is way ahead of the data. And so, what I always remind people is diabetes, obesity, heart disease, none of that develops overnight, right? So, if you're going to treat things related to that, which theoretically are going to improve those disease state outcomes, that doesn't happen overnight either.

So, in terms of getting a total cost of care type of return on investment calculation, that takes several years to actually have it happen. There are studies coming out now, because we are a few years into this that are showing some cost growth changes across different employee groups. But none of those studies are really showing it all inclusively to include the drug costs.

So, they're really just looking at non-GLP-1 related medication costs. Are those individuals using it? Is their total cost coming down? But they're not including the medication. So, we still don't quite have that ROI yet to do that.

So, I think that when you think about, well, if there's no ROI, why do we do this, right? What is that business imperative for your listener? And I think that what you have to remember is that your employees are already dealing with obesity-related diseases. There's already cost to the plan related to those.

And for obesity, there's about 62 disease states associated with obesity, and alongside that, there's about a 60% increase in total cost for someone that has those disease states or obesity itself. So, the plan's already paying for that, regardless of whether you decide to turn on GLP-1 coverage for weight loss or not.

The other piece is competitors are covering, right? And so that ranges widely, though, depending on what sector you're in and the size of your group. So, the larger the employer, we tend to see higher percentages of coverage. But I think it's important for the team to know what does it look like in their competitive landscape with similarly situated employers. Are they covering it? Are they not covering it?

Because if they are and they're not doing it, then there's a talent retention and the ability to hire people because you don't have that ability to provide it. And I think the last thing is really around members are going to find a way to get those drugs regardless of whether you do it.

So there's these compounded products which filled a gap that we had for a while with shortages, but there's can be some serious concerns with that. If they are going through these direct-to-consumer programs, you as an employer lose sight of all of that. Like, you don't get to see it. It also doesn't help them with their out-of-pocket costs for the year, the deductibles and things like that. It doesn't track towards that.

So whether you're covered or not, all of these things are happening, right? So I don't think there's a way to just put your head in the sand and think this is all going away. I think it is really important that the employers that are getting it right are the ones that are thinking about all of this and really trying to find the most comprehensive approach to be able to cover this so that they're on the front end of it, rather than always playing catch up with everybody else.

Monique: Yeah. That's really good. I'm big on metrics, and you hinted to this even throughout our conversation in terms of, one, there's been this boom for the last two to three years of GLP-1 just treating beyond like diabetes, right? So using it as a weight loss mechanism. What metrics should organizations be tracking to determine whether GLP-1 coverage is delivering value to the business?

Ginny Crisp: Yeah. So pharmacy data is not the only thing you should look at. It's a good starting place because you do need to evaluate pharmacy spend and track that. But really, again, you have to have more of that holistic, the complete ecosystem, if you will, of that MEMBER.

So you're going to be looking at the spends on GLP-1s, the adherence rates. So 80% adherence or better has shown more weight loss, more sustained weight loss, and better outcomes. So you really do want to see an adherence rate. Those are both things that your PBM can help you track, what that looks like.

You also want to look at that downstream medical stuff. So for example, is there a reduction in ER visits and hospitalizations or obesity, diabetes-related claims, sleep apnea, those kinds of things? Is that happening, right? Because even though maybe you don't see the ROI immediately, you will start to see those things trend, and that's part of the bigger picture is what's happening in the whole ecosystem, not just with the medications.

But persistence rate's important, so again, I call it a drop rate. It's really the people that are staying on the med or not. Most of the studies have shown after three years, it's like one in 12 people are still using a GLP-1. That's not necessarily a bad thing.

So, if they had weight loss and also lifestyle and they were able to get to their weight and come off the med, but sustain that medication loss, that's a great thing, right? If they were able to do that. But if it's because they can't afford it or they can't tolerate it, that's a different situation.

I think tracking both of those, the persistence rates, the why behind it, is important. And then there's the non-financial stuff like absenteeism, short-term disability claims, and workers' comp claims. So we know that those all are improved when you handle obesity and you treat it. So those are things that you could have a baseline measurement, and then you turn it on and see what that looks like.

And then talent, right? So we've talked about retention and the acceptance rate. So when you decide to do this, do you see a change in those numbers? Or if you have an employee satisfaction survey that has benefit-specific questions on it, does that change with having these coverage options?

So those are all the big pieces to it. But at the end of the day, I think the number one financial tracker is really around the per employee per month, and that's separated out by both medical and pharmacy combined and then looking at pharmacy separate as well, is an indicator of which direction you go. Likely you'll see pharmacy go up, but hopefully you see combined go down over time.

Monique: Thank you for sharing that. So with everything that we have discussed today, if our audience feels like GLP-1 medication coverage will be a good addition to their employee benefit program, how can they make the case and connect back to their company's business objectives?

Ginny Crisp: Yeah. That's the challenge, right? It's putting those all together, and I always start with your culture within where you work. So that really is going to drive a lot of the discussion points in your business case that you have, because most of the employers, I think, want the same things, but there's always this friction between cost and taking care of people, right?

And on the HR side, they tend to be the ones forward-facing to the MEMBER who doesn't get access to the drug or who can't afford it, versus someone who's more on the maybe C-suite, the CFO, for example. The cost is really important to them as well. So it's a balance of bringing both of those things in.

So I think, again, building that case around what does your data tell you today? So you already have individuals on your plan that are obese. They already have conditions related to that. It's already costing the plan money. What does that look like? And then that gives you a picture of what your utilization might look like, so then you can model out the cost of what it might be.

Again, hopefully you can get a lot of this information from your PBM, what the net cost would look like, and sort of track and trend that, but building that along with a plan. So incorporated into the cost, you really want to talk about how are you going to roll it out, right? Or is it going to be just adopting the PBM strategy, or are you going to try to do something custom?

And I think when you model the pricing, different pieces of that can be brought in to give you different price points. So, changing the MEMBER cost share, what does that look like? What does it look like to add the lifestyle modification requirements in there? Those kinds of things.

So when you bring it all together, you're not just asking leadership to do a leap of faith, right? You're actually giving them a plan that they can feel more comfortable with, that there's an option here. And there's always a phased-in approach, too. So it doesn't have to be something that happens immediately and overnight.

I think that's where you can start to incorporate some of these direct-to-consumer, direct-to-employer programs in the thought process of where does this go with cost? And just knowing that it's all changing pretty much on a daily basis, so staying on top of that. But knowing that right now we're probably talking about worst-case scenario on the price. It's going to come down over time, and we're going to see a better financial picture with that.

Monique: Wow. So much to consider. So thank you so much, Jenny, for sharing your insights with us.

Ginny Crisp: Yeah, absolutely. It was a pleasure to be here.

Monique: Well, that's going to do it for this week's episode of Honest HR. We'll catch you next time.

Monique: Hello, friends. We hope this week's episode gave you the candid tips and insights you need to keep growing and thriving in your career. Honest HR is part of HR Daily, the content series from SHRM that delivers a daily newsletter directly to your inbox, filled with all the latest HR news and research. Sign up at SHRM.org/hrdaily. Plus, follow SHRM on social media for even more clips and stories. Like, share, and add to the comments, because real change starts with real talk.