Excellus BlueCross BlueShield
GLP-1 drugs like Ozempic® and Zepbound®, have gained significant attention in recent years for treating both diabetes and assisting with weight loss. As their popularity rise, employers face a unique set of opportunities and challenges, particularly regarding cost management and employee wellbeing.
What are GLP-1 drugs?
Originally designed to help manage type 2 diabetes by regulating blood sugar levels, these medications are now frequently prescribed for weight loss. However, this increase in demand has had an impact on overall pharmacy spending, making it essential for employers to pay attention to how these drugs affect their health care costs.
Why should employers care?
One major concern is the skyrocketing price of GLP-1 medications. Pharmaceutical companies are charging Americans 10 times what they do in other countries. The rising appeal of GLP-1 drugs for cosmetic weight loss has led to a significant increase in off-label prescribing, which can result in unnecessary claims, legal or ethical dilemmas and the risk of poor health outcomes for individuals who may not receive the right support for their condition.
How Excellus BlueCross BlueShield (BCBS) helps employers manage this trend
As the GLP-1 landscape evolves, we are dedicated to keeping our policies aligned with the latest data to ensure the best outcomes for your team.
On January 1, 2025, Excellus BCBS made updates to our prior authorization criteria to align with bariatric surgery standards. BMI requirements were increased to greater than 40 mg/kg2 or greater than 35 mg/kg2 with one more weight-related comorbidity. We did this to focus our resources on members facing the highest risks of serious medical issues and life-threatening complications.
To combat inappropriate prescriptions and further ensure the safety of employees, we employ utilization management programs. The prior authorization process requires providers to certify that a member is enrolled in an approved weight loss program and meets the necessary medical criteria for GLP-1 therapy. This approach maintains access to treatments while managing costs.
Through this management of GLP-1 use, Excellus BCBS has realized cost savings, as indicated by the graph below:
What we know about the future of GLP-1 drugs
In 2024, there were significant advancements with GLP-1 indications. Zepbound® received an expanded indication for the treatment of sleep apnea. Wegovy® gained approval for reducing the risk of major adverse cardiovascular events.
As of January 2025, Ozempic® is now approved for use in patients with type 2 diabetes who also have chronic kidney disease. Many manufacturers are now exploring new approaches. More than 15 new obesity medications are expected to gain approval over the next five years.
Partner with Excellus BCBS
While GLP-1 drugs can enhance employee health, they must be used responsibly. By partnering with Excellus BCBS, employers can better control costs, protect their bottom line and ensure their workforce receives the appropriate care.