Plan coverage of GLP-1s for weight loss: Compliance considerations 

High cost and increasing demand for GLP-1s for weight management has many employers considering cost-containment measures for coverage in their employer-sponsored group health plans. This GRIST reviews compliance considerations for popular measures, including preauthorization requirements, contemporaneous weight management program participation and other utilization management techniques, cost-sharing adjustments, prescription drug plan steering, and coverage exclusions. Also included are compliance considerations for midyear changes to a group health plan’s GLP-1 coverage for weight management, and a review of market forces and clinical considerations that may impact a plan sponsor’s coverage decisions.

Download the 16 page print-friendly PDF to read the full GRIST.