| With the rising success of cash-pay options for GLP-1 drugs from Eli Lilly and Novo Nordisk, more healthcare companies have been talking to me about how to grow the self-pay market for weight loss drugs. |
| It's a concept that lets an employer offer a benefit to cover some of the cash price for weight loss medication, but without actually having the drugs on the company's coverage formulary through its PBM. For instance, an employer could cover $200 of the monthly cash price, with the employee on the hook for the rest. |
When we first started hearing of these direct-to-employer initiatives, my editor Drew asked me the very fair question: Is this just a lighter-touch middleman? Let's call this plan design... the littleman.
|
| The littleman approach offers some advantages for a unique drug category. Many Americans get health benefits through their employer, and they want to use them. But when it comes to obesity care, only about 20% of employers with more than 200 employees in 2025 offer coverage for GLP-1s used for weight
loss. |
| "I think the direct-to-patient model fills a lot of current gaps, but I think the direct-to-employer model is actually a more sustainable model," Bethanie Stein, president of Humana’s pharmacy business, including CenterWell pharmacy, told me. CenterWell is a dispensing partner to Novo Nordisk’s NovoCare Pharmacy, which offers self-pay pricing for the company’s GLP-1s. Direct-to-employer programs, Stein said, is something the company is "currently exploring." |
| It’s an area manufacturers are exploring, too. |
| "For us, it's just important to understand how we play a role there," Dave Moore, executive vice president of US operations at Novo Nordisk told me. |
| And Jennifer Mazur, LillyDirect general manager, said that there’s an opportunity to look at the employer market differently. |
| "We're trying to expand access for patients, and doing that within the existing constraints of our current delivery is not proving to be effective," Mazur said. |
| If my conversations at HLTH last week are any indication, I’d expect you’ll be reading a lot more of these "littleman" type of arrangements in this newsletter over the next few months. |
| - Lydia |
| P.S. - We’re officially one week away from our Health Tech Day! During the virtual daytime portion, we’ll be chatting about the impact of the Trump administration on health tech, what’s ahead as the IPO market had a slight thaw this year and AI’s evolving role in how healthcare is paid for and delivered.
Then, (if you’re in NYC) I hope you’ll join me for an in-person happy hour, including a conversation with Maven Clinic CEO Kate Ryder. Get your tickets here. |
