Employers Turn to Carve-Out Strategies to Control GLP-1 Costs, Increase Access: Eric Levin

As the demand for glucagon-like peptide-1 (GLP-1) weight-loss medications surges, employers and pharmacy benefit managers (PBMs) are turning to new savings tools and navigation platforms to rein in costs without cutting off access. In this interview with The American Journal of Managed Care^® (AJMC^®), Eric Levin, CEO and cofounder of Scripta, explains how carve-out strategies—such as pairing Scripta’s marketplace-style comparison platform with programs like RXSaveCard—allow plans to bypass opaque rebate-driven pricing and instead split the predictable cash-pay cost of drugs purchased through direct-to-consumer channels like Lilly Direct.

By providing transparency into real-time pricing, coupons, and support services, Scripta’s GLP-1 Navigator helps members compare insurance and cash options, ensuring they understand trade-offs and avoid overpaying in a rapidly shifting marketplace.

Check out part 1 of this Q&A for more of the interview.

This transcript has been lightly edited for clarity.

AJMC: How can employers or PBMs use savings tools and navigation programs to manage GLP-1 costs while keeping treatments accessible?

Levin: In terms of managing GLP-1s today, it's a quickly moving landscape. So, the answer I give you today could be different from the one that's in 30 days. But what I tell you today is that what we see as probably the best system on the market is one of our partners, RXSaveCard, which allows you to essentially carve out your GLP-1 coverage for weight loss from your plan and then create a payment methodology. Essentially, it’s like a credit card that lets you pay for the medicines when you buy them from one of the less expensive direct-to-consumer options, and then you can split that cost between the member and the plan.

That sounds complicated, because it's health care, so everything's complicated, but at the simplest level, if the insurance company charges $1300 for a GLP-1, maybe there's a $600 rebate. Nobody knows exactly what it is, but let's say the net cost is $500 or $600, but you don't really know that when you're in your deductible period, the member's going to have to pay that full amount; that's coming out of their pocket when they hit their deductible. Maybe it goes down to $50 or $100 or $150 a month if they have a co-share plan. It could be 20% to 80% of that. It's still going to be expensive, whereas we know the exact cost when you buy from a cash-pay pharmacy.

If you're buying it from Lilly Direct, for example, you know it's going to be between $299 and $499 a month. Now you're able to say—if you're an employer— ”Let's just carve it out. We're going to use our save card and Scripta, and what we'll do is we're just going to put up half, right? So, we'll put up $250, the member will pay the rest.” That way, $250/$250 is pretty fair, relatively affordable, still a lot of money, but compared with $1200 or $1300, very affordable. And then both parties know exactly what they're going to spend. That's why we really like that. It just gives everybody access to the lowest price on the market and complete transparency to what they're going to spend.

Right now, today, that is the program we recommend most to our clients, because it's the best program out there right now, we believe. But that's going to continue to change as well. What we do is stay on top of the market. We have a GLP-1 Buying Guide inside our app, and it's updated constantly, and it will always tell you by category here's who's selling what, here's what they're selling it for, and here's the link. Prices do change and vary, and one of the other things to keep in mind is that some of the places you can buy them will also come with support. Some of them will just sell you the drug, and then you take it, and that's it. But some of them will actually give you some sort of clinically based support, whether it's psychological help, coaching, or weight-loss coaching. There are a few different ways to think about it if you're going to go on these, and we try to put those all in one place and just help aggregate that information so people aren't chasing it all over the internet.

It is shockingly hard to figure out. One of our inspirations for this, I was trying to help somebody I know with this, and I was getting lost, and I said to my team, “We’ve just got to pull this all together in one place, curate the information, and make it a lot easier and give a trusted spot that people can try to keep up with this very rapidly changing market.”

AJMC: How do tools like Scripta’s GLP-1 Navigator help patients find the best prices and avoid overpaying for medications?

Levin: That is our role. It is very difficult for a consumer to try to figure out what it is they can do to get the medicine they need at the right price. The market is becoming more and more complicated, as I mentioned, with cash pay options, TrumpRx, direct from the manufacturer, insurance, or no insurance. We will sit on top of the benefits. We're typically a benefit that is offered by a company as part of their benefits, and we'll help the member essentially comparison shop. We'll let them know who's selling it, what prices they're selling it at, what the potential trade-offs are, and put it all into one comparison shopping app.

Think of it like Hotels.com, except you're not finding a hotel; you're finding that medicine that you need and at the best price you can find it at. You figure out where you can shop, and if there are coupons you can apply, we'll show you that as well. We're in this world where consumerism and health care are supposed to be the way that these plans are set up. People have high deductibles; they have copays so that they'll be thoughtful, but they don't necessarily have the information, nor do their doctors, to be really thoughtful about it. We are just trying to make that information easily and readily available in the way that it is for almost everything else. We buy things that are far less important than our medicine. We spend a lot of time and have a lot of tools on how to shop for, and we think there's no reason that that shouldn't be happening in the pharmacy space.