Give clients a smarter way to manage GLP-1 coverage for weight management
GLP-1 demand continues to put employers in a tough spot: respond to growing interest in coverage or protect against rising long-term pharmacy costs. Premera gives producers a stronger way to lead that conversation by shifting the decision from all or nothing to a more strategic benefit design discussion.
New GLP-1 coverage options give employers flexibility
As GLP‑1 use grows, employers want options that better fit their goals. We’ve created two new solutions that support their population needs, risk tolerance and financial strategy. This structured model helps support clinically appropriate access, manage utilization, and improve cost predictability—without forcing employers into broad open coverage or a full exclusion.
Why it matters
GLP‑1 coverage decisions involve tradeoffs among cost, access, and outcomes. Choosing the right option starts with understanding employer priorities and balancing cost, member experience, and use.
Some options use tighter controls. Others offer more flexibility or broader access. More access can increase use. Tighter controls can help manage costs. These tradeoffs help frame coverage decisions.
Our new solutions
GLP-1 Access Select
Access Select manages cost while allowing coverage. It sets a BMI threshold of 35 for weight loss GLP‑1s. Members with a BMI of 27–34 must also have two related health conditions.
GLP-1 Clinical Select (medical indication only)
Clinical Select supports members who need GLP‑1s for medical reasons, not weight loss. It’s designed for groups that don’t cover weight loss GLP‑1s today. Coverage includes FDA‑approved conditions such as heart disease, sleep apnea, and MASH/NASH.
Optional lifestyle and behavioral support programs can still complement a client’s strategy, but they’re not required to access pharmacy benefits. That gives producers more flexibility to recommend an approach that helps clients meet market demand, support appropriate access and act as responsible financial stewards.
Contact your Premera account representative for more information.