The wild west of GLP-1s & specialty meds: What employers need to know.

Marie Holmes: Perfect. I think we are pretty good to start. So, everyone, thank you so much. I do apologize, my camera is not, is not functioning at the moment, so if I can get it to work, I may just pop on, but, Welcome today to our webinar, and thanks so much for joining. We know pharmacy benefits, particularly around GLP-1s and biosimilars, have become kind of just, like, this urgent and complex challenge, that employers are all facing, quite frankly.

So we're excited to be here with the team from Right Way, so Chad and Sean. We're gonna dig pretty deep into these topics today. Together we'll share strategies, real-life examples, and key plan design questions that can help you make informed and confident decisions. So before we jump into that, let's kind of take a look at what we're going to be covering today. So we'll start with, like, grounding ourselves in what's happening in the pharmacy space right now. So, current state point of view, right? Like, what are we looking at and talking about? So we'll focus on some trends and pressure points that we're seeing most often across our employer and client-based plans. From there, we'll pivot into biosimilars. So we're gonna deep dive into what they are, where the opportunity lies within them, potentially, and how to evaluate your current approach, and really, is it capturing the value that they actually offer. Then we'll switch gears into GLP-1s, which, as I'm sure most of you understand and know very well, is a category that is just seeing explosive growth. And causing a lot of employers to revisit their strategies, right? Because we're seeing change, just quite frankly, on a daily basis. We'll talk through cost containment levers, strategic plan design considerations, and what to watch and look out for in your current… with your current vendor partners and your current setup. Then we'll finally, we'll wrap up with live Q&A. So if any questions pop up in your head throughout the presentation, feel free to put those down in the Q&A box in the chat, and we will get to those at the end. We will make sure that we leave some time, for that. So with all of that, I'm going to jump into some quick introductions. So my name is Marie Holmes. I'm a solutions consultant here at NAVA. I work with employers and clients to support benefit strategies. So, what does that mean? I help them evaluate plan design. Identify areas of opportunity for cost containment, and really just try to educate so that our client base feels like they're making very confident and well-informed decisions. I'm super excited about this conversation today. I'm a pharmacy nerd through and through, and it really has become, like, point critical, for our finance and HR teams, that we support to really understand, sort of, this complex space. And I'm thrilled to be joined by Sean and Chad today from the Rightway team, so I will turn it over to Chad for his introduction. So Chad, take it away.

Chad Frazier: Yeah, thanks, Marie. I appreciate, you letting us be here today with you. Again, I'm Chad Frazier, Vice President of Sales here. In the Western U.S, and glad to be here. Excellent. Sean, if you wouldn't mind introducing yourself.

Sean Earle: Thanks, Marie. Hey everyone, I'm Sean Earle, I'm Director of PBM Specialty Pharmacy Strategy here at Rightway. My focus is on strategies that help employers navigate the complex and fast-changing world, especially medications, from managing the high-cost therapies to optimizing access to emerging therapies. I'm passionate about finding smarter, clinical, sound ways to reduce spend. without compromising care, and I'm excited to walk through some of the most impactful strategies we're using with clients today. I appreciate, Murray, and I'm excited to get in the slides. Awesome, sounds great. Alright, so before we get into kind of the meat and potatoes of everything, I want to take a moment to introduce NAVA, for those of you that may not be familiar with NAVA and sort of how we approach this benefits space. So our mission here at NAVA is to help make, high-quality, affordable healthcare more accessible, to everyone. And we believe employers play a very critical role in making that possible. So, we work with HR teams, every day who are navigating, sort of, this issue of rising costs, limited resources, and a healthcare ecosystem that feels really unnecessarily complicated at times. So that's why we're hosting this session today, to help bring some clarity and awareness around a really complex topic that a lot of folks really just have a lot of questions around. So, of course, the pharmacy space. Well, we're not the ones particularly writing the formularies, right? That's our partners here at Rightway. We are helping our clients just ask better questions, understand the options that they have available to them, and really push their vendor partners for strategies That align with their goals from a cost containment perspective, and also just from a member access and care standpoint. So with that, I'll kind of quickly show a snapshot of just how Nava shows up differently in the benefits space, and how that connects to sort of what we're going to be talking about today. So we approach benefits brokerage a bit differently here at NAVA. We're very, very hands-on, and we take that full-fledged, hands-on approach, just not during milestone season, so think strategy, renewal season, right? We really take that approach throughout the year. We find a lot of value in sort of staying in front of our clients on a very consistent cadence and basis. So that shows up in sort of how we explore cost-saving strategies. We really offload a lot of the administrative and sort of transactional work that our clients are kind of just dealing with on a day-in, day-out basis. We offload that and really take ownership of that through our technology and resources. And sort of our final pillar is how we support employees directly when they have questions or need help navigating the benefits that their employers are offering to them. So oftentimes, we found that the end user, which is the member, your employees and their dependents, sort of get lost in the shuffle in the client-broker relationship. So that is really one of our guiding principles, just to ensure that that end user, the members, are really kept, kind of, part of this mix, and a really important part of it. So our goal is to make benefits just manageable for employers and more accessible for employees, and pharmacy is a huge part of that, so that's why we're having this conversation today. So with that, I'm going to turn this over to Chad to introduce RightWay, and then we'll jump into the clinical side of the presentation. All right, thank you, Marie. Appreciate it. Alright, so let's just jump into this here. I have two slides I want to go through, do a brief introduction of right way, and then I'll turn back over to Marie and Sean. I'll go through the core of the content here. So, when you think about Rightway, Rightway as a whole is a healthcare technology and benefits services company. We specialize in both clinical navigation and pharmacy benefits management. So truly, really our mission is to help employees and members navigate the complex world of pharmacy and drive towards lower costs, lower net costs, better outcomes, and just really happier members. you know, we looked at the PBM space for a long time, and for too long, really, plan sponsors, I think, really fell trapped, you know, from the legacy PBM model. You know, Rightway has really taken that model and flipped it on its head, if you will, and delivering a better experience through modern technology, a fully aligned business model. And our unique patient navigation and advocacy approach, which we'll talk a little bit about that, later through the program. So, Rightway has over 1,500 clients, 2 million members, clients such as Robin Hood, Riot Games, Instacart, you know, Tyson Foods, just to name a few of them. You know, we brought to the market, the PBM market, what was missing. Things such as modern technology, transparent pricing, member-level and concierge support through our intuitive mobile app. you know, our approach is really different than most PBMs. We put patients at the forefront of everything we do, providing personalized support and guidance, to help navigate the complex world of pharmacy. Essentially, right way is, to become the pharmacist in every family of… for every member, for those groups. And for your members. Go ahead and flip to the next slide. So I just want to talk about 3 core differentiators that set us apart from any other PBM. One is our modern technology, both from a claims processing and member-level engagement. Rightway as a platform was built really for the modern PBM landscape. We have an intuitive mobile app that I mentioned, giving members access to such things as their prescription drugs in real time, ID cards, plan design. Members can call in, chat, or message with a live clinical pharmacist. Two, really, our clinical-first approach, as we call it. Live clinical pharmacists and pharmacy techs at a member's fingertips. that proactively provide savings opportunities, such as maybe lower-cost alternatives, or a cheaper way to fill, such as enrolling a member into Mark Cuban Cost Plus, or switching from Walgreens to Costco. And then three, and lastly, our plan sponsor alignment. We have no conflicts of interest from retail, mail, order, or specialty ownership. No spread pricing or rebate retention. We pass 100% of that rebate back to the client. And then we have a simple, transparent admin fee. And then lastly, our strong PBM PMPM financial guarantees that we offer our clients. I know today we're going to hear from Sean, Director of Specialty Strategy. He'll talk about GLP-1s with Marie and our biosimilar approaches. So, from a 30,000-foot view, that's a little bit about Rightway, and I'll turn it over back to you, Marie, to continue us forward.

Marie Holmes: All right, wonderful. Thanks, Chad, I appreciate it. Alright, so I had mentioned during, kind of, our agenda slide that I really do want to spend some time just sort of to get a lay of the land of where is the entire pharmacy ecosystem, right? So not just GLP-1 and biosimilar, but, like, the whole thing fundamentally. So I'll unpack this slide a bit more here. So, pharmacy is becoming a growing cost driver, right? So, historically, employers have focused just predominantly on medical cost containment. And the trend we've seen over the past few years is that pharmacy trend is actually outpacing medical trend at this point, and it's quite significant. And this is very especially true for self-funded entities, right? So, self-funded plans. One major factor, kind of, in the rise of this trend… trend is our GLP-1 medication, right, and the introduction of that in different areas. So GLP-1s were medications that were originally approved for type 2 diabetes. But they're now being used, for weight loss, and for some off-label use as well. And really, they're becoming a brand new blockbuster category that really none of us had kind of on our radar, if you would think, 5 years ago. So analysts have forecasted that this class could actually reach $100 billion globally in a short 5-year span. And we're really already seeing some employer clients that have, like, just very significant GLP-1 spend, sort of driven by that weight loss sort of, you know, category. But we're seeing 5-10% of total prescription spend is potentially going to GLP-1s alone. So that felt very doom and gloom, right? But we also have the opportunity for some cost savings by way of biosimilars. But the trend that we're seeing in that space is that it's potentially being a missed opportunity here from a cost savings perspective. So, biosimilars, very, very, you know, high level, are just generic versions of biologics. Sean will talk about, sort of, the clinical kind of aspect around that, and what that really truly means, but at their core, they are a generic option. So despite being clinically equivalent and cheaper than the brand alternatives, we're not seeing a market shift that we would have expected for a, you know, for a new generic kind of entry to the market. And why is that happening? And oftentimes, what we're seeing is PBMs are blocking them blocking the biosimilars from their formularies, kind of for a multitude of different reasons, and some of it is a rebate play, right? So, the most famous example, I'm sure everyone is probably familiar, is Humira, which, has had a biosimilar competitor on the market for well over a year now, and many, many biosimilar options available to us now in that space, but we've only seen about maybe a 2% shift of market share from the brand Humira to a biosimilar. So, what that means is 98% of those prescriptions that are being filled for an adalimumab are still being filled through Humira, which, again, is just not an area that we would have expected. We would expect to see a larger market shift over to those biosimilars or those generics. So, that brings us to kind of, like, the bigger question, right? Like, what is the employer decision point that we kind of should all be mapping here? So many current PBM models sort of operate on a rebate-first model. Which sounds really, really good on paper, but oftentimes ends up limiting access to lower-cost drugs just by way of the nature of that rebate-first model. So, more and more employers are considering transparent, pass-through PBM partners like RightWay that prioritize access over rebates, right? So we're talking the acquisition cost of the drug over, sort of, the net rebate cost of the drug. These pharmacy dynamics are kind of exposing flaws in the current sort of traditional system, and we think that employers have real opportunity here to kind of lead the change and lead the charge, maybe towards that transition into a more transparent pharmacy benefit management world. So, with all of that said, I'm going to turn it over to Sean to get into the clinical nuts and bolts of the conversation today.

Sean Earle: Thanks, Marie. I appreciate that, and yeah, we'll dive in a little bit deeper here, and we'll start with biosimilars. You know, it's one of the, like Marie mentioned, one of the most powerful tools right now employers have, to tackle rising pharmacy costs. Like she said, they're under-leveraged, and that's not an exaggeration. Like she said. you know, 2% at the start of the conversions, it's creeping up to 10-20% of biosimilar use at the moment for the market share. Comparing that to generics, which is well over 90%, you know, we still have a lot of room to move on this. These drugs deliver the same clinical results as their brand name counterparts, but at a fraction of the cost, and I'll go over it. Sometimes. 75% to 90% less. But yet they're still sitting on the sidelines. you know, kind of like, you know, Marie said, why? The structural roadblocks, formularies that prioritize rebates over savings. But the good news is, I think people are starting to see that, and it's a huge opportunity for us to navigate this space. So on the next few slides, we're going to unpack what biosimilars are, why they're such a big deal, and most importantly, how you can start tapping into the potential to save money and improve care. Let's go to the next slide. Okay. So let's ground ourselves, take a minute to see what biosimilars actually are, and why they're such a powerful but underutilized lever for employers. So, what are they? So, biosimilars are essentially highly similar, but not identical versions of FDA-approved biologic medications. So the key point is that they have no clinically meaningful differences in terms of safety, purity, potency compared to the original biologic. So, from a clinical standpoint, they're just as effective as the brand name drug they're modeled after. So, why that matters? Because biosimilars are priced lower than the original biologics, they open up more treatment options at a lower cost. like Marie mentioned, you know, help curb some of that pharmacy spend that's happening right at the moment, which can be a game changer, both for plan sustainability and for improving patient access to life-saving therapies. So how are they approved? You know, unlike generics, which are chemically synthesized, biosimilars are a little bit more complex. They're made from living cells, so this means the approval process is also more complex. These drugs go through extensive testing to ensure they perform just like the reference product. So while they're not simple generics, they're held to extremely high standards, and that's part of what makes them both clinically trustworthy and financially attractive. So some common misconceptions, you know, a lot of confusion still exists out there. You know, many people think they are generics, you know, they're not exactly generics, they are far more complex to manufacture and regulate, but the bottom line is they're safe, effective, and underused. So, the value is so clear, why aren't we seeing wider adoption? We'll explore that on the next few slides, and I think you'll have a better understanding, but I don't believe it has anything to do with clinical concerns. So now that we know a little bit more about biosimilars are, and why they're such a big deal, let's talk about how you can actually put them to work, slash pharmacy costs. The goal here is simple, should be simple, is to get to the lowest net cost possible without compromising care. And so, how does Right Way make that happen? It's about 3 key strategies. First, we build an evidence-based formulary. That means we prioritize drugs, especially biosimilars and generics, based on hard data, you know, on cost and effectiveness. No guesswork, just what works best, using the clinical data for the members. at the lowest cost. Second, we bring in rigorous clinical oversight. Our policies guide prescribers to the most cost-effective options, like choosing a biosimilar, while keeping patient care front and center. And third, we use smart clinical programs leveraging technology to make sure medications are used safely and efficiently. No waste allowed. The best part? We tailor all this to fit your needs. Whether you're… you got an in-house pharmacy you'd like to use, or a specific partner preference, that is how you lock the full power of biosimilars and keep your plan sustainable. So next, we'll look a little bit more about how we do this in action, specifically around autoimmune. So, zooming in on autoimmune conditions, which is, you know, obviously one of the biggest cost drivers in the pharmacy spend today, and the most opportunity. We're going to walk through how to manage them smarter, starting with where most plans are today, and anywhere with the gold standard. And this will kind of allude back to what Marie mentioned on the adoption rate and why plans are still chasing rebates. So first, that's what we're talking about. This is where a lot of plans are right now. It's a traditional setup, relying almost entirely on high-wack, brand-name drugs like Humira, Stellarin, Enbro. They're placed on the form layer because of rebate deals, but these rebates are tied to very high list prices. So even though the rebates are coming in, your net costs remain high, drug spending keeps climbing, though there's really no cost containment strategy here, just focusing on rebates. It's simple, it's outdated, financially unsustainable, and it's not transparent. So then next, looking at the status quo on the chart a little bit lower, some employers have taken a small step forward. They are using biosimilars. But they're still not optimizing, what they could be doing. And the issue is, they're using more expensive biosimilars. Marie mentioned it already. It's usually often private label versions being manufactured by the PBM managing the plan. These biosimilars do not generate the savings they should, because they're priced similarly to the brand drugs they replace, or they're still tied to rebates. Plus, this strategy really lacks clinical guardrails, so members can switch to more expensive agents like Skyrizzy, Cocentix, and Talts. Still playing the rebate game. driving up costs further. So it may look like it's progress on paper, it's not delivering any meaningful savings, with drug spend actually growing yearly by 8% on average. So then looking up at the better version, Phase… Phase 1, this is where things start to improve. We moved to a low-wack formulary, focusing on the lowest cost biosimilars. With clinical guardrails to prevent switching, to the higher-cost brands, like the status quo model, the model follows FDA clinical guidelines and adds some cost controls, delivering about 200,000 annual savings compared to the current status quo model. And then lastly, Phase 2, this would be the gold standard. You build a biosimilar-only formulary for anti-TNF and IL inhibitor therapies, the most cost-effective versions of these drugs. If a brand name drug is still needed. We optimize the pharmacy network to make sure it's sourced at the lowest cost possible. There are some clinical guardrails in place to reduce unnecessary switches and support programs to ensure smooth experience for members. And the results here are massive cost reductions, often thousands of dollars per prescription without compromising quality of care. This is where the biggest, most sustainable savings live, and you'll see the potential in the next couple of slides when we start to discuss numbers. Okay, so getting to the good stuff here, some real-world actual numbers, we're gonna start, to show how biosimilars can save a ton of money. We're gonna start with Humira, and… you know, like Marie mentioned, you might have some… some exposure to this. The first biosimilar came out 2 years ago, and it's really been transitioning over the past year. But we're going to compare Humera here to the biosimilar Usimerie. Breaking it down compared to the traditional PBM, with the brand name R rightway with the brand name, and then the biosimilar version. So, looking at a traditional PBM here. Starting with an AWP price, just over $8,000. You know, after network discounts and rebates, you're talking about around $3,500 per prescription for that drug. And then with Rightway's, you know, full transparent pass-through rebate, structure, you're gonna see the same drug, costs $1,000 less, just under $2,500, if the brand is still the preferred option for the plan. What I really want to look at here and what we're talking about is biosimilars. So now looking at USimary, we're talking at an AWP price, just over $1,000, and after discounts, just over $600. So there's no rebates to Chase, just a flat, transparent price. And then adding in the shipping cost here, you're talking about $639 for a USimbry for a patient per month, compared to $3,500 for the brand. So that's some nice savings here. And the best part about all this, and the very important part, is just not just saying, hey, we're switching you over, you're going to the biosimilar, you know, like Chad mentioned, Brightway was founded as a navigation company, so we're really set into it where our pharmacy guides help make this transition seamless for your members. And we'll talk more about this in a few slides, but it's really important to help the members get to the low-cost options without any hassle, so they get the same great care, keeping thousands of dollars per claim for the client. And then, let's flip to the next slide. I think this one's gonna have a little bit more, hitting home for a lot of people, because it's more on today's everyone's radar, because we're going to talk about Stellaro. So, looking at the Stellara here, the numbers, I think you're gonna see, some nice savings potential. And you might have already seen Humera, because, like I mentioned, it's been out for a couple years now, and the biosim approvals, you know, are starting to happen now for Stellara, so you may not have seen these numbers as much, so… If you haven't seen anything around Stellaro, buckle up. There's gonna be a lot more savings potential here, with a higher cost biologic here. So, looking at Stelera for traditional PBM, Brightway, and then the biosimilar OTOLFI, looking at the traditional AWP, over 30… close to $35,000, after network discounts and rebates, you're talking about $15,500 per prescription. Once again, if the client prefers this option. Rightway's gonna provide the same drug, $1,000 cheaper, with the full pass-through, transparent rebate model that we have. But really want to look at, once again, the biosimilar option here, where the savings can really be captured. So, AWP for tall fees, just over $4,000. No rebates, but after discounts, we're talking about just over $1,000. Comparing that, you know, to the brand name of over $15,000 per month, that's over a 90% savings. And once again, the most important part is how are these being transitioned for members, you know, to get to the most cost-effective options without any hiccups? And they get the same quality care while the plan is seeing savings over $170,000 per member per year. And that's… I think that's very impactful to have an understanding of compared to the Humira. Yeah, there's some good savings on Humira, but still are a very great opportunity here. And in the next slide, we'll kind of mention more about how this process, how we get this to work. And, we'll go through that. So you've seen how biosimilars like autofi can save thousands, hens of thousands per prescription, but you're probably wondering, how do we actually make this switch happen without disrupting the member's care? So we'll walk through our 5-step biosimilar conversion process. It's smooth, clinically driven, and all about keeping everyone happy. So, let's start with the prescriptions being received. The provider prescribes it. Let's go with the option of Stelera. Our platform instantly flags this as an opportunity for savings. So, step one, our pharmacy intervention. Our team jumps in, you know, checks the formulary. to spot biosimilar alternatives that deliver the same results for less, just like we went over from Steleridol toffee. Step 2, provider communication. So our pharmacists just don't send email, voicemail to the provider. We jump on a phone call, have a real clinical conversation with the prescriber to get buy-in to switch to the biosimilar. And a lot of providers already have a lot of buy-in. we're hesitant, I would say, at the start with you, Mary, but seeing the clinical outcomes over the first couple years. Prescribers really are not hesitant to make that switch anymore. Step 3, member redirection. Once again, it's not an email. Our pharmacists contact the members to inform and discuss any… with the members any questions or concerns about the biosimilar conversion, ensuring the member is educated and has confidence in the switch. And this could be a phone call, this could be a chat, it just depends on what the member prefers, because we have an app that we can leverage as well to make sure we're finding the member where they want to be. Step 4, copay maximization. So if there's a copay assistance program out there, we enroll the member, keep their out-of-pocket costs as low as possible. And then step 5, benefit optimization. So, the member gets the right drug, a biosimilar at the fraction of the cost, saving thousands or tens of thousands per script. The best part, the whole process is seamless. It's led by clinicians who know their stuff, and is designed to make the member experience foreverless. No hoops to jump to, and this is how we turn the big savings into reality. So, you're not just having it say, hey, formulary's just cutting it off, and then the members reaching out to the prescriber or to the HR department to say, hey, I got this letter in the mail. We're taking that proactive approach to have those discussions with the prescribers. and the members. And kind of like what Maria mentioned. 2% at the start for adoption rate, getting to 10-20% adoption rate, and this process is showing right way adoption to be in the mid to high 90s, which is very impactful, not just for the member, but also for the savings that we're able to capture here. So, I'll pass this back to Marie now, so she can talk about some questions you should be asking your PBM.

Marie Holmes: Awesome. Thanks so much, Sean. That was a great overview of, kind of, just, like, the proper, sort of, multi-dimensional approach to biosimilars. Like, it is possible to start getting the adoption that we want to see in this space, and it is a very real, you know, possibility for a lot of us on this call. So to close out this section, I had mentioned earlier, you know, we'd like to provide just sort of some, you know, tangible action items right now, so I think an area that's really worth exploring is just understanding, like, what is flowing through your plans currently, right now? And I do think a lot of these questions are very appropriate, regardless of your current funding arrangement, right? So I think a fully insured entity, it absolutely matters if you're seeing biosimilar adoption or not under your plan, just as much as it matters for a self-funded, you know, self-funded employer. So, a lot of these are going to be focused around just sort of fact-finding, data mining, right? Like, what's happening in our world. So, first and foremost, understanding what the percentage of, like, your biologic spend currently is on the reference product, so that's really the brand, versus biosimilars. Like, where is… what is our starting point? Are we having any adoption whatsoever? Our biosimilar is automatically substituted, right? So that's kind of the furthest end of the spectrum, but understanding just, is that substitution happening? And if yes, then we're probably seeing a higher adoption rate, of course. If it's not. then we kind of continue to drill down with some questions. So, how does your particular PBM's formulary prioritize the biosimilars. versus the brand name reference-based drugs, right? So, Sean had mentioned a lot of our, you know, PBM partners in the space, they are manufacturing their own, right? So is their drug, is their biosimilar the only one that's on the preferred formulary list, right? I think it's worth knowing those, you know, worth asking those questions and knowing the answers to those. What is the current rebate structure currently in contract for reference versus biosimilar products, right? We want to make sure, is it auditable? Is it not auditable, right? Like, what rights do we have as plan sponsors to get that information? Now, in the fully insured space. Rebate stuff is probably not going to be disclosed to a fully insured entity, but when the time comes that, you know, potentially you are talking self-funding, that is a question that matters very, very much. And then finally, what clinical education or member outreach is in place right now to kind of, you know, to spearhead that biosimilar adoption? Sean just went through Rightway's approach. Let's understand what the other partners are doing. Is it right? Can we tweak things? Do we need to pivot? And I neglected to mention this, the… this webinar is going to be shared, the recording, so don't feel like you have to write these questions down. You'll be able to kind of take a screenshot later, so the recording will be shared out with you guys.

Sean Earle: Awesome, okay, let's shift over to GLP-1s now. I think that's a topic, hot topic, everyone's mentioning, like Marie said, it wasn't on anyone's radar 5 years ago. And, you know, we've just seen how biosimers can provide savings on autoimmune drugs. And let's pivot now to this game changer. that's probably making a big, big dent in the pharmacy spend, GLPs. So, these drugs are… these drugs are absolutely reshaping how we think about pharmacy spend, and if you haven't felt the impact yet. you're an outlier, outlier. We're talking about how meds like Ozempic and Wegovy, which are making headlines, not just for their cost. But also for their credible health benefits. So they're transforming lives, helping with everything from diabetes to weight loss, heart health. sleep apnea, and many other indications coming down the pipeline. But here's the deal. The rising demand is putting some serious pressure on employer plans. So, what do we do about it?

And so today we're going to talk about and dive into what GLPs are, what Why they're such a big deal, and most importantly, how you can manage their costs while still delivering those life-changing outcomes for your members. Okay, let's dig into GLPs and get a handle on what they are. all about. So, you heard me mention Ozempic and Wagovi. But what exactly are GLP-1s? So they're hormones in your body that help regulate blood sugar, insulin, and even appetite. So GLPs mimic these hormones, and they're absolutely powerhouses. So, originally developed for type 2 diabetes, they've exploded onto the scene for weight loss and cutting cardiovascular risk. So, why did it matter? So, because they're delivering jaw-dropping results, helping people shed pounds and prevent chronic diseases like never before. There's a flip side here. The popularity is driving spend costs through the roof. So, we're talking about a market that could, like Marie mentioned, $100 billion by 2030. And potentially eating up 10% of your pharmacy spend. And I use 2030 because there will not be any relief from biosimilars until at least then. So this is only going to get larger spend for your groups. So, employers are at a crossroads. You want your members to access these life-changing drugs, but you gotta keep your plan affordable. That's the challenge we're tackling, and up next, we'll look at a few smart strategies to balance those costs with the incredible benefits GLPs won't bring. So, as you mentioned, you know, GOPs are a powerhouse, but they're pricey. So how do we make them work for your plan without breaking the bank? It's all about a smart, tailored strategy that treats patients' groups differently, because a one-size Does not fit all here. Our approach breaks it down into four key areas.

So first, looking at diabetes. If your member is already on a GLP-1, we keep them on track, no disruptions. But here's a stat to chew on. About 40% of diabetics stop their medications, so we focus on adherence to keep them healthy. For new patients, we guide them through an evidence-based progression, minimizing unnecessary switches to GLP-1s.

And then second, additional disease cohorts. We look at folks with cardiovascular and comorbidities. GLPs can be a game changer here, but we evaluate the ROI to make sure it makes sense for your plan.

And third, weight management. Prediabetes is a big deal here. 70% of those patients could become diabetic in 5 years. We don't just throw drugs at it, we pair GLPs with programs which use incentives to support lifestyle changes. And then fourth, the triple risk. So for members with multiple comorbidities, we cover GLPs strategically to maximize that tripling. Better health, better experience, lower cost. So behind the scenes. We're analyzing your population to surface the best strategies, whether it's, you know, tightening the belt rules, like lifetime caps, or boosting adherence. The results, 63% of our PAs shift to lower-cost therapies, and 100% are backed by evidence. This isn't a cookie-cutter approach, unlike the big PBMs. We customize your goals, keeping costs down and outcomes up. Next, we're going to look at, you know, specific ways to balance access and affordability. Now that we've got a solid strategy for managing GLPs across different patient groups, but how do we actually put this action to keep costs in check while giving members the care that they need and want? So that's where we're driving into now. So there's 5 practical ways to balance Access, cost, and outcomes. So, think of this as a menu. You pick what fits your goals. So, like we mentioned, there's not a one-size-fits-all here. So, first up, open access. This is full coverage option. Anyone who meets the clinical criteria gets GLP-1s. It's great for access, but can hit your budget hard. Second, open access… or second, step therapy. Before starting GLPs, members join a behavioral program to build healthy habits, which can boost outcomes and lower long-term costs. Then third, patenting access control. So here, we limit eligibility, say, to members with a high BMI, and require PA to keep utilization in check. And then fourth, cost sharing strategy. So we can use tiered co-pays or employer offsets to make GLPs affordable to members without having them foot the entire bill. And then fifth, targeted coverage. So focus… GLPs on high-risk members with multiple comorbidities, maximizing impact where it counts the most. The beauty of this is, like I mentioned, it's not a one-size-fits-all approach. Unlike the big PBMs, we work with you to mix and match these options, tailoring them to your specific population and budget. Whether it's boosting adherence or setting smart guardrails. we've got you covered, and you know, that's… that's really, we think, is the best approach right now with GLPs until the biosimilars hit the market. So, appreciate the time on this, and I'll pass it back to Marie so she can share some questions to ask your PBM. Yes, awesome. Thanks again, Sean. So that was a wonderful overview, again, of just, like, what can be done in the GLP-1 space to sort of just, like, get… let's get some constraints around what's going on. But again, to close out this section, similar to what we did with the biosimilars, I want to offer just additional some questions, right? Again, a lot of this is going to be fact-finding. What's… what's flowing through our plans currently. So first and foremost, what is our current plan cost, kind of on a per-member count and spend basis, for both FDA-approved and potentially off-label, right? We don't anticipate we're going to see a lot of off-label spend, but if we do have it happening in our plans, we want to know about it. How are we monitoring GLP-1 adherence and persistence over time, right? So that's an issue that we hear from employers a lot, is people hopping on and hopping off the drug. Is the ROI worth it, right? Kind of that conversation. So, how are we monitoring this, right? Like, is there a way that we can kind of keep our finger on the pulse there? Do we require any participation in lifestyle or coaching programs, kind of, in conjunction with the GLP-1 therapy? So, you may or may not be aware of that. There might be something happening behind the scenes. And if not, then what are the options that we do have available, right? I think some clinical guidance indicates that having some behavioral and lifestyle components in conjunction with the GLP-1s really does get us to the best, you know, kind of end result, especially when being used for weight loss. What are the guardrails in place to prevent the off-label use that we really shouldn't be seeing, but if we are, like, what can we do to kind of prevent some of that? And in that space is, of course, the weight loss vanity prescribing. Next couple of questions are going to be focused around, you know, what can we do from a plan design perspective? Can we cap the plan's monthly or annual exposure to GLP-1s? What creative, you know, what creative plan design solutions can we… can we deploy, to start turning the tide on some of this, you know, on some of this spend? And then finally, again, are just going to be focused on rebates. How are we tracking the rebates specific to GLP-1s? And can we see what the actual was, right? Like, what was in our contract, and what's, what's projected? So, understanding, you know, are we getting what we were promised, you know, when we kind of, at the point of engagement here, making sure that that is happening. So we definitely want to have some visibility to that.

Marie Holmes: Alright, so that kind of wraps up the sort of pharmacy piece, you know, of the presentation.

Marie Holmes: So, with all of that said, I'm going to jump into the Q&A, and we did get some awesome questions. I think the first one we did touch on, but Sean, I think it would be helpful just to kind of double-click on that. So, first question is, do biosimilars go through the same… same level of testing as more traditional pharmaceuticals, so FDA testing, all of that kind of stuff. Can you just speak to, like, how that approval process works, right? And just, you know, making sure that it's vetted and valid.

Sean Earle: Yeah, that's… that's a good question. So, as mentioned here, like, categorized as supplements. So, no, it's… it's not categorized as supplements. It's gonna go through a rigorous FDA testing, procedure, just like, you know, generic medications, you know, it's just… it's different because it's not a generic medication, it's… the molecule is more complex, so it just has to go through a little bit different of approval process. So, it's still taking, you know, 8 to 10 years. to get… to get approved, you know, hundreds of millions of dollars, to go through these processes. So, the FDA standards are to make sure that there's no clinical meaningful differences from the reference product. And, you know, as of April of this year, the FDA has approved, you know. 50 to 60 biosimilars already, so just, you know, for Humira alone. So, they're not categorized as supplements, and it's going to be just as trustworthy as the approval process for the last 100 years for medications.

Marie Holmes: Okay, alright, that's perfect, very helpful. Alright, so kind of keeping in the biosimilar theme, I'll try to segment these out. How do we, as employers and plan sponsors, Sean, know that, like, what our PBM is preferring is actually the lowest cost biosimilar, and not just kind of like a private label version that sort of looks cheap on the outside, but isn't actually, you know, when you get into the nitty-gritty of it?

Sean Earle: Yeah, so, you know, I think it's important, the transparency piece with your PBM is vital. I mean, I think what you can do here is to ensure that you're asking, you know, requesting for the full rebate pass-through, prohibiting spread pricing, asking for detailed reporting here to find out what they're picking for their option. like I mentioned, and it's happening daily, you know, where the larger PBMs are manufacturing their own. And the prices are not even close to where they should be compared to other biosimers, but they're still being preferred on the formularies. So, it's still playing that rebate game, and they're still playing that spread pricing to take that and, you know, pacify shareholders.

Marie Holmes: Very good, that's helpful. So Chad, this one might be one that you actually might want to jump in for, so… With mentioning, sort of, that Rightway has no specialty conflict of interest, do you find more plan sponsors are beginning to use, sort of, the modular model when it comes to carving out specialty prescriptions, you know, in particular? So sort of what Blue Shield of California did, right? So they kind of, like, removed that from their standard traditional PBM. Do you find this to be a successful strategy if plan sponsors have an appetite for this, and are there any challenges that, you know, a plan sponsor should potentially be aware of in that world, if they're considering that approach?

Chad Frazier: No, I mean, I think, If you look at what the big booca's did. Blue Cross, specifically here in California, where they're, you know, having conflicts of interest, and they're carving out those specialties and having, point solutions tacked on, you know, like an OptiMed or a, you know, Payer Matrix to help with those types of things. We're willing to work with those types of outfits. We do all of our specialty in-house. That's a lot of stuff that Sean was talking to, is our clinical rigor and the things that we do. We'd rather navigate that through house and then outsource that specialty piece of it, if that makes sense. Okay. Yeah, so I could just kind of make it muddier, right, from start to finish to take that approach. Okay, that's helpful. Sean, back to you. Do employers have any responsibility to assess, like, the increasing evidence of long-term adverse impacts in the GLP-1 space specifically? Or is that, like, for the most part, a decision between the patient and their clinician or their healthcare provider? What are your thoughts on that? I would love to kind of hear your… your insight.

Sean Earle: I think employers, yeah, they should always be up to date on, you know, the increasing evidence out there, but it's going to be up to the, you know, the patient, the healthcare provider, and the PBM to look at what's the most, you know. up-to-date data that's provided. I mean, there's data coming out now that's talking about the rebound if they go off of GLP-1, so you really lose that ROI. You know, how do we combat that?

So, I do think it's important, because this spend, as we mentioned, is just going to get larger and larger, and more people are going to want to take the medication, as they see more of the dramatic effects of the weight loss. So I think it's important to watch that, but if you're working with a, you know, a PBM who has… who is aligned with you on this, you know, they're going to take a lot of that off your plate. Alright, very good. Sean, what is the timeline for realizing cost savings if an entity moves to a biosimilar first kind of formulary approach? Like, what is… what is the tale on that?

Sean Earle: You're gonna start seeing… You're gonna start seeing cost savings pretty quickly, but you're gonna start seeing a very big impact after a quarter, quarter and a half. You're gonna start seeing it as members are filling those medications and getting them transitioned over. To see the full effect, you're going to want to see in about 6 months, but, you're gonna see, you know, cost savings right away when you move over to the biosimilars.

Marie Holmes: Okay, alright. And, do biosimilar strategies apply equally across, like, all autoimmune conditions, or are there certain areas that we should focus on first, where savings potentially could be greater, right? Like, let's get the lowest hanging fruit, or is it kind of across the board similar?

Sean Earle: Across the board, I would say, I mean, you can get it. I mean, they're not changing them by indication, it's just the biosimilar for all the different indications here. So, I think when you run your analysis on your patient population. you just can look at it from the originator product, and then seeing what could potentially be done from a biosimilar one, so… With Stellera having multiple indications coming out now, you're gonna see it across a lot more… Disease states.

Marie Holmes: Okay. Just like you did with your mirror. Okay. So switching over to GLPs, like, behind the scenes, what does it look like when a member, you know. kind of, you know, presents with a prescription for a GLP-1 that doesn't have diabetes? Like, what goes on behind the scenes to ensure that that drug is, you know, that that person is eligible, is, you know, should be receiving this drug for weight loss? Like, what does that look like behind the scenes?

Sean Earle: Yeah, good question. So they're going… they're going through, the same process to make sure that they… we have all their clinical data to make sure that they have the right indications to get the medication, because like… like you mentioned, asking the questions, is anything being done, outside of, you know, off-label uses? And that's important, because that's going to really help curb spend, so all those things go into play to make sure that they have a, you know, an FDA-approved use for the medication, going through all the clinical policies that we have in place to make sure that they meet those before that medication gets, dispensed. Okay, alright, that's perfect. And then what, do you recommend step therapy or lifestyle program requirements before approving GLP-1s? Like, are, you know, are there any additional kind of gatekeepers that we should be considering putting in place first, to, you know, just kind of keep control over this spend?

Sean Earle: Yeah, yeah, especially, for the weight management indications. You know, we often recommend pairing, the GLP coverage with, behavioral programs here, and just to ensure that the medication is paired with sustainable lifestyle changes, and that's going to improve the long-term outcomes. Okay.

Marie Holmes: Alright, let me just scroll here. So kind of merging the two, are there any emerging biosimilars for GLP-1s that we should keep on our radar? Like, you know, any kind of… what's going on in that space, or is there a dissection or intersection of these two points?

Sean Earle: Yeah, so, Not… nothing in the near future, like we both mentioned, like, it's gonna be probably closer to 2030. I could even see it getting pushed out farther when the tourmies get involved, with the amount of value that these drugs have for drug manufacturers. So right now, you know, there's nothing that… on the horizon, but we're keeping a close eye on that. So we're able to move those over, just like as you saw with the biosimilars for autoimmune diseases, the amount of cost savings, is going to be very impactful when these do go, biosimilar. Okay, alright. And Sean, what, in your opinion, Chad, kind of to you as well, what percentage of your… the, you know, right-way book of business, the right way population, does have GLP-1s coverage for weight loss versus, you know, kind of specifically excludes them? Do you guys know that stat off the top of your head?

Sean Earle: I don't know if Chad was gonna jump in there or not. No, I don't think I do know that, but it's a great question, it's a good takeaway. I think it's close to 80% before this really started to hit, and it's hovered right around there, I think, like, maybe a little bit closer to 70% now, as we continue to add more to our book of business. You know, they're reaching out daily and weekly on strategies how to, you know, curb the cost on these, but there's still a lot of them covering it.

Marie Holmes: Right, right. So, kind of doubling down on that, you know, an employer maybe that potentially had covered it, but now they're sort of… they need to pivot, right? They need to figure out a way to control cost. how do we, you know, as plan sponsors, ensure continuity of care, like, and avoid member disruption, and sort of just, like, a lot of noise, potentially, that we could hear, when we're changing approaches, potentially, on GLP-1s or biosimilars, right?

Sean Earle: Yeah, no, exactly, and I think it's a stepwise approach, and it's never just a complete cutoff of the program. It's usually, like I mentioned, there are stricter controls, for them, and so there's a lot of conversations, with members and prescribers, you know, if there needs to be change… changes that are happening, just like we do with the biosimilars. We have those clinical discussions, and if formularies change, we're pro- proactive about that with members, so they're just not, you know, it's just not showing up as a reactive situation for them. So… most of them are not just completely cutting off, they're trying to go other routes by adding that lifestyle program first. Or, you know, we're looking at other ways, too. Can you deprescribe some? Can they be on lower doses? Different things like that. It's usually not just a complete cut-off situation, so it's not as bad of a member disruption, but there's a lot of communication that goes into play, and making sure everyone's aware of the changes that are happening with their plans. Okay, alright, that's very helpful. Alright, so we're gonna have one more question, and then we will, you know, kind of let everybody go. But, I'll throw out, just from, like, a strategic sort of planning standpoint, what tools or data would be helpful for an employer if they're, you know, to have at their disposal, right, if they're considering. whether or not they should be, like, making changes in this space, right? So, like, what are some questions, some reports, right? Just some data points that would be helpful as we go through this process and vetting what's the right solution.

Sean Earle: Yeah, that's a great question, and I'd say the first thing is it's got to be real-time reporting. You know, getting reporting, quarterly or, you know, twice a year isn't going to really make that much of an impact for you to make the changes that need to happen, so that real-time reporting needs to include, you know, especially drug utilization, you know, looking at the reference versus biosimilar adoption, just so you can see how that's Actually, you know, driving cost savings, net cost trends, and then, obviously, having, like, an opportunity analysis, looking at different medications, different disease states where you could have some opportunities to be proactive in that approach to find more cost savings. So, you know, we also do ongoing strategy reviews, so that's something that needs to be done, you know, if, you know, you want the real-time data, but you're not always into it. If you want, you know, someone like right away, your PBM to be looking at it, we're always doing that to make sure that you're, you know, the plan is staying optimized on the newest, but also the The cost-savings, driven, therapies out there.

Marie Holmes: All right, very good. Well, that was awesome. Thank you again, Chad and Sean, for joining us today. I hope everyone, you know, got some good nuggets of information out of this. Again, this recording will be shared out, so, you can reference anything talked about, but, thanks again for your time, everyone, and have a great rest of your day.

Chad Frazier: Thanks, everybody. Appreciate it. Thank you.

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