Rising prescription drug costs are top of mind for employers, and GLP-1s are partly responsible. The drugs — while proven highly effective — come at a hefty price tag, leading to many employers having to make tough decisions around GLP-1 coverage for weight loss.
Recognizing this, Eli Lilly launched Lilly Employer Connect on Thursday, a platform that provides tailored coverage options for obesity care in partnership with over 15 digital health companies. However, while the platform provides more flexibility for employers, it isn’t a monumental improvement, at least one expert says.
The Lilly Employer Connect partners (called program administrators) range from benefits administration to more holistic obesity care models with wraparound support. They include 9amHealth, Andel, Calibrate Health, Crux Health, eMed, FlyteHealth, Form Health, Goodpath, GoodRx, Ilant Health, Mark Cuban Cost Plus Drug Company, Onsera Health, ReviveHealth, SALTA Direct Primary Care, Sesame, Teladoc Health, Transcarent and Waltz Health.
Employers choose which vendor they want to contract with and gain access to Lilly’s Zepbound Kwikpen at a discounted price of $449 for all doses. Total costs to the employer depend on their choice of pharmacy and program administrator. Out-of-pocket patient costs vary depending on the cost-share model the employer chooses with the program administrator, so the price employees pay for the medicine is likely below $449. The typical price for a 1-month supply of Zepbound ranges from $299 for 2.5 mg to $699 for 15 mg.
“Lilly is working to close the access gap in obesity care. With nearly half of commercially insured Americans lacking coverage for obesity management medications, we recognize that employers need flexible, transparent solutions that complement existing benefits,” said Kevin Hern, senior vice president of Lilly Employer, in an email.
One employer advocate is excited to see innovation around direct-to-employer drug offerings, noting that this program helps employers get away from the rebate-driven model offered by most big PBMs, which have come under scrutiny for their lack of transparency. Eli Lilly’s program, however, provides small advancements but nothing major.
“This isn’t revolutionary, but it shows incremental improvements in flexibility for employers seeking to provide access for these expensive drugs that are increasingly requested by employees,” said Shawn Gremminger, president and CEO of National Alliance of Healthcare Purchaser Coalitions. “The price point is competitive but doesn’t appear to be substantially lower than the price employers were already getting.”
The real shift with Eli Lilly’s program is the more flexible approach to delivering GLP-1s to employees, Gremminger added.
“The evolution here has been radical,” he said. “Two years ago, drug companies and PBMs were collaborating to fight against independent vendors offering GLP-1s at a discount in coordination with greater oversight and health coaching to the point that employers were losing their rebates if they hired one of these vendors. Today, GLP-1 manufacturers are fully embracing this approach and working with vendors and employers to provide better access to these drugs.”
Another health expert, meanwhile, stated that the Lilly Employer Connect platform provides employers with more control, more choice and greater clarity on costs. She added that it also reflects the rise of digital and direct-to-consumer platforms that have recently gained traction to increase access to GLP-1s.
“At the same time, the market is likely heading toward price compression, as competition increases from digital/direct-to-consumer players, specialty compounders, and emerging small-molecule oral options entering the obesity treatment space,” said Beth Mosier, healthcare M&A director at consulting firm West Monroe. “Lilly recognizes both the scale of the market opportunity and the economic impact of obesity, which contributes to more than $1.24 trillion in lost productivity.”
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