A strategic objective right now is leveraging direct-to-consumer (DTC) pricing models – either through integrated plan options or by allowing access outside the traditional benefit. An important consideration with DTC pricing models is that utilization management is often limited or absent. This can potentially open access and lead to increased off-label utilization. The conversation continues to change as legislation evolves, transparency increases, and rebate dynamics shift toward lower point-of-sale (POS) costs.

In addition, many employers are exploring partnerships with point-solution vendors that offer more comprehensive obesity management solutions. These programs typically combine medication access with lifestyle interventions, such as nutritional counseling, physical activity support, and behavioral coaching, along with prescriber coordination and oversight, to ensure appropriate utilization. Coverage can be contingent upon participation in these structured programs, often delivered through digital platforms, live coaching models, or a hybrid of both.

PBIRx also sees growing interest in pulling more traditional levers, such as placing these medications on higher formulary tiers or tightening prior authorization criteria. While these approaches may help manage utilization, they can come with negative consequences – most notably reduced rebates. Currently, these drugs receive significant manufacturer rebates. Achieving meaningful cost control through these plan design changes typically requires significant member cost-sharing, which can introduce potential access and adherence challenges. However, as the landscape shifts towards lowest POS costs, the rebate factor shrinks.