Turning 40% GLP-1 Cost Trend into Over $1M in Savings Through Data-Driven Plan Design
Instead of relying on standard reporting, an employer leveraged Artemetrx to identify off-label GLP-1 usage and implement custom plan design changes resulting in over $1M in savings and a drastic reduction in GLP-1 cost trend.
The Challenge
The client’s diabetes GLP-1 category grew 40% year-over-year, well above expectations. The increase was not driven by a single factor. Claim volume was rising, refill thresholds were not addressing discontinuation, and utilization patterns suggested that not all members on GLP-1 therapy had a clinical need consistent with an on-label indication.
The PBM’s existing utilization management framework was not designed to detect these specific drivers. The prior authorization policy in place required only prescriber attestation rather than clinical documentation (e.g., lab results) to confirm medical necessity. This created a gap where members without a confirmed type 2 diabetes diagnosis could receive and maintain GLP-1 coverage. Standard refill thresholds were also not calibrated to address the waste generated by members who were discontinuing therapy early but still filling prescriptions at regular intervals.
Without visibility into the intersection of pharmacy and medical claims, the client had no mechanism to separate clinically appropriate utilization from off-label use. The cost trend would have continued to accelerate with no targeted intervention available through standard PBM programs alone.
PSG’s Supporting Services
Artemetrx: An integrated platform that transforms data into intelligence, driving improved management of drug spend and trend across both the pharmacy and medical benefits.
Clinical Consulting: Our team of experienced pharmacists provides unbiased clinical expertise to help clients make informed decisions that optimize their plans.
Learn More
GLP-1 spend and trend can easily skyrocket if not managed correctly. Download the case study to learn how you can spot inappropriate GLP-1 usage and implement the necessary changes to improve your trend and enhance your savings.