GLP-1
GLP-1: The First Drug Category That Acts Like a Budget Line
4 min read
•December 2025GLP-1 isn't "just another Rx category." It behaves like a budget line with a growth curve. That's why it freaks out finance—and why HR gets stuck in the middle between outcomes and affordability.
Control Architecture
The winning strategy isn't denial or chaos. It's control architecture. If you manage GLP-1 like a system, you can protect outcomes and protect the plan. If you manage it like a headline, the headline wins.
The 5 Pillars of GLP-1 Control
- Eligibility rules: Clear, defensible clinical criteria (BMI, comorbidities, etc.)
- Re-authorization: Checkpoints tied to actual outcomes or adherence
- Escalation monitoring: Tracking dose increases because that's where cost accelerates
- Discontinuation tracking: Understanding churn changes your forecast significantly
- Member experience: Designing the process to minimize friction and blowback
What to Measure
- New starts vs maintenance %
- Escalation curve over time
- Persistence/discontinuation rate
- PEPM impact forecast at 2x adoption
- UM approval rates + friction signals
What to Do Next
Don't wait for the renewal shock. Model your exposure now. Understand your current utilization curve and implement the control architecture before the budget breaks.
Want your GLP-1 exposure modeled?
We can help you forecast the impact and implement the controls.
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