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Sustainable GLP-1 solutions that balance access with affordability
Unprecedented demand, rising costs, and clinical complexity require a more strategic approach to GLP 1 management—one built for engagement, control and flexibility.
A smarter approach to GLP-1 management
GLP-1 therapies are rapidly reshaping cardiometabolic care. As demand grows, employers must balance access to clinically valuable therapies with long-term pharmacy benefit sustainability.
A new approach to ultization
Sustainable GLP-1 programs require more than coverage decisions. They require coordinated utilization strategies that align access, clinical oversight, and engagement.
Evernorth® supports GLP-1 management strategies designed to balance access, affordability and measurable outcomes. Use this consultant GLP-1 solutions guide to confidently align your clients’ GLP‑1 strategies with the right mix of clinical programs and utilization controls—delivering sustainable cost management, improved outcomes, and flexible benefit design.
Scale of the challenge
Traditional pharmacy benefit designs were not built to manage therapies with this scale of demand.
More than 40% of U.S. adults are living with obesity, contributing to rising cardiometabolic disease and health care utilization.1
$1,200+ is the average monthly cost of GLP-1 medications when used long term.2
The GLP-1 challenge employers are facing
GLP-1 therapies represent a significant shift in cardiometabolic care. As utilization expands, employers must balance clinical opportunities with plan sustainability. These pressures are turning GLP-1 coverage into a strategic utilization challenge— not simply a benefit design decision.
Employers today face several competing pressures:
Rapid growth in GLP-1 demand
High and sustained treatment costs
Variability in prescribing practices
Rising employee expectations for access
Pharmacy innovation is accelerating rapidly. Explore industry insights on pharmacy trends shaping employer health strategies in the Pharmacy in Focus report.
Coverage alone isn’t a strategy for GLP-1 utilization
GLP-1 therapies are redefining employer pharmacy strategy. Coverage decisions alone are rarely sufficient to ensure sustainable clinical and financial outcomes.
Traditional pharmacy benefit models were designed for medications serving smaller patient populations.
GLP-1 therapies differ in several important ways
They address highly prevalent conditions and require sustained engagement to deliver meaningful outcomes. Many organizations are moving beyond simple coverage decisions toward more structured GLP-1 utilization strategies.
Without a structured GLP-1 utilization strategy, it can be difficult to sustain:
Uncontrolled pharmacy cost growth
Inconsistent prescribing patterns
Low long-term adherence
Limited clinical impact relative to spend
A modular approach to GLP-1 utilization strategy
Employer populations and benefit strategies vary widely in their priorities. Some emphasize broad access, while others prioritize cost containment or clinical safeguards. These goals can be supported through a modular approach to GLP-1 management offered by Evernorth, including the following key components:
Access design
Coverage parameters and eligibility criteria aligned with employer goals
Utilization management
Prior authorization and clinical safeguards designed to support appropriate prescribing
Member engagement
Behavioral support and adherence programs to help sustain treatment outcomes
Financial protection
Analytics and monitoring designed to manage pharmacy trend and utilization
Integrated programs that streamline management
Effective GLP-1 programs require coordination across pharmacy benefits, clinical programs, and engagement services. These capabilities are integrated within the Evernorth ecosystem to simplify program administration while strengthening oversight and member experience. Integration across capabilities helps employers maintain stronger control over GLP-1 utilization while reducing operational complexity.
Core program capabilities:
Automated prior authorization and safety edits
Clinical oversight and monitoring
Specialized pharmacy support
Fraud, waste, and abuse monitoring
Engagement drives measurable outcomes
Medication access alone does not guarantee meaningful health outcomes. GLP-1 therapies require sustained engagement and adherence to support lasting metabolic health improvements.
Evernorth EncircleRxSM combines utilization management with member engagement to produce measurable results.1
$400M+
client savings achieved
2M+
pounds lost across enrolled members
~40%
reduction in client pharmacy trend
80%
of members exceeded engagement benchmarks
GLP-1 medications are transforming the weight management landscape—but medication alone isn’t enough. Provider guidance, patient engagement and technology-enabled care can drive stronger adherence, better outcomes and more sustainable results.3
Control without compromise
GLP-1 therapies represent an important advancement in cardiometabolic care. Their rapid adoption requires thoughtful benefit design and utilization strategy.
Employers implementing structured GLP-1 strategies can:
Maintain appropriate access to treatment
Improve long-term adherence and outcomes
Protect pharmacy budgets from rapid growth
Simplify benefit administration
Start building a sustainable GLP-1 strategy
Evernorth supports organizations seeking to move from reactive coverage decisions toward more proactive GLP-1 utilization strategies that support both employee health and plan sustainability. Programs supporting sustained engagement have also demonstrated meaningful clinical outcomes, including an average 7.7% decrease in member BMI.1
Employers need strategies that balance access, engagement, and cost control. Evernorth provides strategies and integrated programs that support sustainable approaches to GLP-1 utilization.
Sources
- EncircleRx Book of Business First-Year Results data, 2025. Results may vary.
- Evernorth Pharmacy in Focus report, 2025.
- Cigna Healthcare provides access to virtual care through certain third-party service providers. Such third-party service providers are solely responsible for the care and treatment they deliver. Benefits are subject to plan terms and conditions, including applicable exclusions and limitations. These services may not be available in all areas.