Rising GLP-1 Demand Pressures Conventional Employer Drug Benefits

In the second of his three-part Pharmaceutical Commerce interview, Jay Bregman discusses how rising demand for GLP-1 therapies is challenging employers to reassess how they manage pharmacy benefit costs, as rapid uptake and high list prices strain traditional coverage models.

According to Bregman, many employers—ranging from small organizations to those with tens of thousands of covered lives—are increasingly finding that conventional tools such as step therapy and utilization management offer limited financial relief while also generating employee frustration. At the same time, increasing consumer awareness of GLP-1 pricing through direct-to-consumer platforms has intensified scrutiny of the prices employers ultimately pay through the existing pharmacy benefit system.

Against that backdrop, Bregman notes that the dynamics of the pharmaceutical distribution model itself are beginning to shift. Drug manufacturers, which have historically relied on intermediaries to reach employer-sponsored plans, are showing growing interest in exploring more direct commercial relationships. In Bregman’s view, emerging models that connect manufacturers, employers, and employees more directly—supported by technology and greater pricing transparency—could reduce administrative layers and inefficiencies embedded in the current system. He suggests that such approaches may represent a natural evolution of the market as stakeholders search for ways to address the cost and access challenges associated with high-demand therapies like GLP-1s.

In this interview, Bregman discusses how employers are weighing coverage decisions amid surging demand for these treatments, why manufacturers are reconsidering traditional distribution channels, and how new direct-engagement models could reshape the pharmacy benefits landscape.

Access the first part of our three-part video interview series with Bregman:

-Direct-to-Employer Drug Purchasing Emerges as Companies Navigate High Prescription Costs

A transcript of his conversation with PC can be found below.

PC: GLP-1 adoption has grown sharply over the past two years, and employers are facing real decisions about how to manage the associated costs. How are you seeing employers approach those tradeoffs when it comes to their pharmacy benefit offerings?

Bregman: So look, I think we've spoken to clients as small as a couple hundred lives, and we've spoken to consultants that represent clients as large as a hundred thousand lives. And they say exactly the same thing, which is, "It's just completely unaffordable," right? And, "no matter how many step therapies, utilization management, whatever we put in, the employees become more upset. We don't really save any money. The utilization keeps going up. It's just impossible to manage. Oh, and by the way, we don't really know what this product costs, but we can see on all these direct consumer platforms what it does, so why aren't we getting that price?"

What’s driving manufacturers to pursue direct relationships with employers, and how might that change the broader distribution ecosystem?

Look, I mean, I think if you talk to any company that sells to any kind of, employer, they would much rather sell directly than sell through an intermediary. I think that for a variety of reasons, both political, regulatory, et cetera, that has, you know, the current system has been maintained for a long time. I think now that's changing, and it's changing real fast, right? So I, I think basically the optimal solution to this problem is a cooperative model like the one that Andel is putting in place, where there is a direct relationship intermediated by technology with transparent pricing between the employer, the employee, and the manufacturer with as little corporate overhead, as little waste, and as much efficiency as possible. So this is just honestly, this is like the natural, beautiful, perfect way to do it. And nature is just returning to its equilibrium.