Can Labor Unions and Funds Effectively Manage the Cost Impact of GLP-1s?

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Can Labor Unions and Funds Effectively Manage the Cost Impact of GLP-1s?

GLP-1 medications, such as Ozempic, Wegovy, and Mounjaro, have transformed the landscape of chronic disease management, particularly for Type 2 diabetes and obesity. While they are effective, these revolutionary treatments owe much of their widespread attention to prominent endorsements in media and pop culture, leading to growing off-label use.

Their growing popularity poses significant challenges for union-sponsored health plans, from ballooning bottom lines to questions about equitable access and member safety.

Balancing Member Safety and Plan Cost

While GLP-1 medications are effective in treating the conditions they have been approved for, they are not clearly better than lower cost alternatives. Unions and fund administrators need to carefully consider all aspects of management to balance plan sustainability and member access.

A comprehensive management strategy for GLP-1s requires a multi-faceted approach. One critical component is the incorporation of optional plan edits, such as prior authorization requirements.

• Implementing prior authorization can help labor unions and funds ensure that GLP-1 medications are prescribed responsibly and only for their approved indications, mitigating the risk of inappropriate off-label use, helping control medical costs, and protecting plan budgets from unnecessary spending.
• Leveraging step therapy protocols to encourage cost-effective alternatives, where clinically appropriate, can be another safeguard to manage costs without sacrificing member care.

These optional plan selections help reduce misuse and enhance the accountability of prescription practices, ensuring that members receive the medications they truly need at the right time and cost.

A complementary strategy to incorporate these optional components is to educate members about GLP-1 medications, including their effectiveness and potential side effects, to foster informed healthcare decisions and encourage healthy lifestyle changes.

Practical Steps for Unions and Funds

To tackle the challenges of GLP-1 use and costs, unions and fund administrators can take these steps to protect their members' benefits:

1. Review Plan Options: Adjust benefit policies to ensure GLP-1 coverage aligns with member health priorities and budgets. Introduce safeguards to prevent improper use of these expensive drugs.

1. Educate Members: Provide clear, helpful information about what GLP-1 medications do, possible side effects, and their proper use. This helps members make informed health decisions.

1. Monitor Trends: Stay informed about new research, emerging treatments, and shifts in approval processes to anticipate how costs and access might change.

1. Partner with a pharmacy benefits optimizer: A pharmacy benefit optimizer (PBO), such as RxBenefits, will introduce cost controls, provide clinical expertise, negotiate better drug prices, and use data to guide decisions.

Moving Forward

The rise of GLP-1 medications highlights the need for unions and funds to adopt proactive, tailored approaches to healthcare management. By balancing accessibility, safety, and cost, coupled with strategic partnerships and smarter plan edits, these unions and funds can continue to provide high-quality benefits to their members.

Staying informed of market trends and policy shifts will further empower them to anticipate changes and make well-informed decisions for the future.

To learn more, visit rxbenefits.com/labor