The Hidden Truth Behind 2024 Anti-Obesity Medication Prices

If Ozempic is procured traditionally, through the PBM, the two-year cost balloons to almost $24,000 over the same two-year period.

So, let’s consider HPHP’s plan design and the strategy behind eliminating patient copays and out of pocket costs. Most plans list Ozempic in the “preferred Brand” category on the formulary. An average “copay” amount for a preferred Brand medication is $60.

So, $60 copay per month is $720 per year, times two years is only $1,440 that the patient would owe over a two-year period.

Plan sponsors can well afford to cover that $1,440 in copays the member would have paid, if they are saving $15,000 in drug costs over the same two-year period.

So, why aren’t more employers doing this? It’s a good question, since it appears to be a no-brainer strategy, right?

It begins with simply knowing what your plan is paying for these medications, and other care. Over a two-year period, if the plan is spending $15,000 less on a prescription, that’s $15,000 that could go into other programs that actually help people regulate their blood sugar and lose weight effectively.

Think of it from this perspective: Employers are paying tens and tens of thousands of dollars for these medications, but are patients/members using them effectively and efficiently? If a person only takes a medication, but does not change their diet and exercise behaviors, the medications are not as effective as they could be. There are also psychological factors to consider as well. Changing lifestyle and behavior is difficult, ask anyone whose every quit smoking, or got their bodies into shape. It also takes a significant amount of mental strength. Medication alone isn’t the answer. People taking these meds often need dietary support and literacy, mental health support, among other services.

If employers are paying far less for the medications, a portion of the savings can also provide additional services for members, to help ensure the medications are being used efficiently and getting the best results for patients.

Now let’s focus more on costs.

Take a close look at this chart, because what self-funded plans are paying is quite a bit different than what the PBM is paying manufacturers for these GLP-1 drugs:

2024 List vs Net Prices for Specified Anti-Obesity Medications (AOMs)

The “List Price” is the price (average) a self-funded health plan pays for the med. The “Net Price” is the price a PBM pays the manufacturer for the drug (average). You can see the “spread”. Some health plans also get rebates on these meds, but it’s hard to determine how much of the rebate the PBM actually keeps. After all, it is your PBM who gets to define what a “rebate” even is.

But even adjusting for rebates, American employers are paying much higher prices. This is why a rebate strategy is not sufficient as the only strategy employers deploy to address cost.

Having a specific strategy for GLP-1 medications is critical. The wave is coming, and right now only a small percentage of people are taking these meds. But as the FDA continues to expand the use of GLP-1s to additional comorbidities, the number of people taking these meds is skyrocketing.

Are you prepared? We are helping employers with this, and many other healthcare issues. Contact us to discuss strategies for GLP-1s.