GLP-1's are the No. 1 question on employers' minds when it comes to healthcare benefits, Kasey Raetz, PharmD, told Becker's. Cigna's EncircleRx program provides some answers.
Dr. Raetz is vice president of product, pharma contracting and strategy at Evernorth, the Cigna Group's health services business.
Cigna launched EncircleRx, a program to help employers control the cost of GLP-1 drugs for weight loss, in March. The program now covers over 5 million people, Dr. Raetz told Becker's.
When the program launched, Cigna described it as the first GLP-1 management program with a financial guarantee for health plans. The program caps yearly cost increases for plan sponsors at 15%.
EncircleRx controls costs through a combination of prior authorizations and lifestyle support, Dr. Raetz said.
"The program is relatively new, but we've had a lot of clients that have really been able to increase patient adherence and get the right patients on the right product, but also reduce client spending," she said. "We're seeing a good, negative trend for clients enrolled in the product."
Interest in the program has continued to climb, especially in the past six to eight weeks, Dr. Raetz said.
GLP-1 drugs approved for weight loss include Wegovy and Zepbound. The drugs can be expensive, costing upwards of $1,000 a month.
Feedback from patients participating in Encircle has been "resoundingly positive," Dr. Raetz said.
"Patients, especially those that are really invested in their weight loss journey, really appreciate the additional support," Dr. Raetz said. "We've overall gotten really positive feedback about the health coaches available, receiving dietary and nutrition support."
Most employers surveyed by the Business Group on Health in 2024 reported being concerned or very concerned about the appropriate use or long-term cost of GLP-1 and other new weight loss drugs.
Despite the concern, two-thirds of employers surveyed by the Business Group on Health cover GLP-1 drugs to treat obesity. The survey included 125 large businesses with a total of 17.1 million employees.
Some large employers have pulled back on coverage for the drugs, citing costs. Earlier this year, North Carolina's state health plan said it would no longer cover GLP-1 drugs for weight loss for employees. The state was spending around $100 million for the drugs, or 10% of all prescription drug spend.
More employers are open to covering the drugs, Dr. Raetz said, but are looking for a way that doesn't break the bank.
The program is designed to work for employers who are just starting to cover GLP-1 drugs for weight loss, and employers who have already covered the drugs, but are finding spending getting out of control.
"Encircle is a really good middle ground that they can get those reassurances that the trend isn't going to go completely haywire, while still giving access for the right patients," Dr. Raetz said.
Employers will also have to grapple with the fact that the number of conditions GLP-1s can treat could expand rapidly in the future, Dr. Raetz said.
Wegovy is currently approved to reduce the risk of cardiovascular death, heart attacks and stroke. GLP-1's could be approved to treat a wide range of conditions in the future, including sleep apnea, kidney disease and substance use disorder.
"If and when these products receive potential additional approvals, we will continue to see employers and health plans grapple with expanding coverage," Dr. Raetz said. "It's not just a weight loss medication anymore. It's treating things that don't have treatment options available."