Service
GLP-1 Management
Strategy for GLP-1 coverage, prior auth, and cost management
GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound) are the fastest-growing pharmacy benefit cost category in the country. Plans that left their formulary defaults in place from 2022 are seeing GLP-1 spend swallow the rest of their pharmacy budget. TeliosRx builds GLP-1 strategy from the ground up: who qualifies, under what conditions, with what utilization management, and what the cost trajectory looks like for the next three years.
We help you make the policy call (cover, don't cover, cover with limits) on a fiduciary basis, not a marketing-driven one, and translate that policy into specific PA criteria, step therapy, formulary tier placement, and member communication.
What's Included
- Current GLP-1 spend analysis and trajectory modeling
- Prior authorization criteria review and recommended changes
- Step therapy strategy (older diabetes drugs first, etc.)
- Formulary tier placement recommendation
- Member communication plan
- Manufacturer copay assistance program coordination
- Ongoing quarterly monitoring as new GLP-1 drugs launch
Our Process
- Analyze 12-month GLP-1 claim history and pipeline projection
- Define coverage policy with plan sponsor leadership
- Translate policy into PBM-implementable PA and step therapy criteria
- Coordinate member communications and rollout
- Quarterly review of utilization and emerging drug pipeline
Who This Is For
Self-insured plans where GLP-1 utilization is growing 50%+ annually and threatening overall plan budget, or plans where leadership wants a fiduciary-driven coverage policy rather than a default decision.