GLP-1 coverage management is a complex landscape, requiring a multifaceted strategy that balances patient access, clinical appropriateness, and financial stewardship. College and university benefits teams are not exempt from these challenges, and some are implementing robust prior authorization and utilization management to help contend with rising costs, while still offering coverage options.
The core challenge for universities lies in striking a balance between the significant clinical benefits of GLP-1s and their substantial budgetary impact. To achieve this, organizations might explore value-based arrangements and could even negotiate directly with pharmaceutical manufacturers to secure more favorable pricing. Having an emphasis on member education and promoting comprehensive wellness programs that address the root causes of conditions like obesity and diabetes can also be beneficial.
Truven led a recent panel discussion on how higher education employers and plans are looking at diabetes and obesity care with GLP-1 management. Let’s look at some key takeaways from three universities that are currently covering – and are planning to cover into 2026 – GLP-1 medication.
Instituting a GLP-1 coverage timeline
The University of Michigan manages its prescription drug benefits completely in-house, covering 125,000 lives, explained Stephen Lott, Director of Pharmacy Benefits. Seeing the demand for GLP-1s for weight loss in 2021, the university has covered them for that since the drugs have been on the market. Starting in 2024, Michigan opted to cover two years’ worth of medication and send notices when the script count is winding down. Starting in 2026, Michigan will start to see individuals who will have exhausted their benefits.
Communication was also key in that process, ensuring that patients were reminded multiple times about how many doses they had left. In addition to updating their websites, Michigan sent letters that, along with reminders on the 24-fill limit, included other resources to assist with their weight loss journey.
Having the right team members in place
The University of Minnesota offers GLP-1 drug coverage to its 42,000 members and noted that investing in the strategy around pharmacy benefits as a whole is critical. Hiring a pharmacist with expertise in pharmaceutical economics and policy helped to ensure that appropriate factors are taken into account when considering eligibility, said Katie Kolodge, Director of Benefits and Time Away.
Looking into the actual prescriber of the GLP-1 drugs is also critical for Minnesota. For example, seeing prescriptions from providers that may not be qualified to prescribe the medications, such as anesthesiology, dentistry, or even emergency medicine could lead to safety concerns, inappropriate use, or a higher cost to the plan.
Balancing the bottom line, member health
Penn State University covers 45,000 individuals on its health plan and also has its own pharmacy benefit carved out. With an increasing number of conditions for which GLP-1s are being approved, the university has also invested in a pharmacy assistant and switched its pharmacy benefits manager.
Finding the right way to balance the university’s bottom line while also focusing on member health is a top priority.
“Why would we discontinue providing a benefit that has proven to be a big effect on health outcomes overall for the general population?” said Rita Bartolacci, Benefits Strategist, Healthcare and Well-Being.
How Truven helps with strategic GLP-1 management decisions
As higher education institutions confront the intricate challenges of managing GLP-1 medication coverage, data-driven insights are paramount for developing effective and sustainable strategies. Truven Health Insights offers robust analytical solutions that empower university health plans to navigate this complex environment.
Our insights enable the objective evaluation of utilization management strategies, such as prior authorization, to ensure these institutions can achieve the desired balance between appropriate access and cost containment. Additionally, Truven’s analytics provide the evidence needed to help employers design benefit structures that align with both clinical best practices and financial realities.
Connect with our team today to learn more about how we can help with GLP-1 coverage and watch the full webinar replay here.
