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Managing the Next Wave of GLP-1 Weight Loss Breakthroughs

by Rx Insights

The GLP-1 landscape continues to evolve rapidly. Along with the recent FDA approval of Novo Nordisk’s Wegovy® oral pill—which we addressed in a separate update last week—additional GLP-1 therapy breakthroughs are delivering promising weight loss results, expanding long-term maintenance use, and broadening the population eligible for treatment. While the clinical potential is compelling, the financial implications for plan sponsors are significant, and underscore why proactive benefit strategy remains critical for employers and health plans.

Next-Generation Weight Loss Drug Developments

Eli Lilly’s latest results for retatrutide illustrate the rapid evolution of weight loss drugs. The triple-agonist therapy, which activates 3 receptors in the body (GLP-1, GIP, and Glucagon) to more effectively manage blood sugar and weight, delivered nearly 29% average weight loss after 68 weeks in patients with obesity and knee osteoarthritis, along with meaningful pain reduction.1 In contrast, existing weight loss injection therapies—including Saxenda®, Wegovy®, and Zepbound®—have demonstrated approximately 10% to 21% total weight loss over a similar timeframe (roughly 54 to 72 weeks).

Concurrently, recent trials have indicated that Eli Lilly is positioning its oral GLP-1 candidate, orforglipron, as a maintenance therapy following initial weight loss. While Novo Nordisk has taken an early lead with FDA approval of the Wegovy® oral pill, Lilly’s oral GLP-1 has also been awarded a national priority review voucher by the FDA2, which could accelerate regulatory timelines. Together, these developments highlight how next-generation GLP-1 drugs may impact both utilization patterns and pharmacy spend, particularly for long-term maintenance treatment.

Looking further ahead, investments in companies like Prolynx points to a new wave of long-acting obesity treatments designed for monthly or quarterly dosing. These innovations would aim to improve adherence and persistence by addressing real-world limitations of today’s weekly GLP-1 regimens, further expanding utilization.3

Benecard’s Perspective

At Benecard Services, we see this moment as an opportunity for smarter benefit design.  Rather than blanket exclusions, we help clients implement clinically informed strategies that balance patient access with long-term cost sustainability. This includes defined treatment parameters, centralized management to enhance oversight, proactive planning for emerging therapies, and alignment with manufacturer programs where appropriate.

For more details regarding Benecard’s comprehensive GLP-1 strategy, please contact your Benecard Client Relations Manager, Sales representative, or visit our Rx Insights blog to view our article on strategic GLP-1 drug management.

Sources:

  1. Lilly’s three-pronged drug puts obesity field ‘on notice’ | BioPharma Dive
  2. Lilly obesity pill, headed for quick FDA review, hits mark in ‘maintenance’ trial | BioPharma Dive
  3. Prolynx banks $70M for longer-lasting obesity drugs | BioPharma Dive

 

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FDA Approval of Novo Nordisk’s Oral GLP-1 Marks a New Phase in Obesity Treatment

by Rx Insights

The GLP-1 landscape continues to move quickly. On December 22nd, Novo Nordisk announced FDA approval of the Wegovy® pill which will be commercialized in the U.S. as of early January 20261. While additional details are still emerging, this approval itself represents a meaningful shift in how weight loss therapies may be accessed and utilized moving forward.

What’s Different About an Oral GLP-1 Therapy

Unlike injectable GLP-1 therapies, the Wegovy® pill is taken once daily. In clinical trials, the oral formulation demonstrated meaningful and comparable weight loss to the Wegovy shot, though outcomes were generally slightly lower than injectable GLP-1s2. This difference is expected, as oral medications are partially broken down during digestion, requiring higher daily doses compared to weekly injections.

Importantly, Novo Nordisk is positioning the Wegovy® pill not just for initial weight reduction, but as a long-term maintenance therapy. This emphasis on maintenance may influence prescribing patterns, adherence expectations, and duration of therapy—all key considerations for plan sponsors.

Why This Matters for Plan Sponsors

While pricing details are still emerging, this approval validates that GLP-1 innovation is shifting from injectables to more versatile, patient-centric formats. The upcoming Wegovy® pill’s commercial launch reinforces the potential for broader utilization, longer treatment durations tied to maintenance therapy, and ongoing needs for clinical oversight and formulary alignment.

At Benecard Services, we view this approval as further confirmation that benefit strategies must evolve alongside rapid GLP-1 breakthroughs. As therapies expand in form and function—from triple-agonists to long-acting formulations and now oral agents—thoughtful benefit design and proactive planning are critical.

We are actively monitoring ongoing developments and will share deeper analysis and strategic guidance in the weeks ahead. For now, this approval serves as a timely reminder: the next phase of GLP-1 therapy is here, and preparation matters.

Sources:

  1. Press Release: Novo Nordisk A/S: Wegovy® pill approved in the US as first oral GLP-1 for weight management
  2. With FDA approval of Wegovy pill, new era of oral GLP-1 weight loss drugs begins.

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Update: NJ Government Proposes $260 Million Rescue for SHBP-LG

by Rx Insights

Since we first reported on the topic in June of this year, the financial crisis facing the New Jersey SHBP-LG has only deepened — and NJ Governor Murphy is now proposing a dramatic rescue and reform plan that many labor leaders have already denounced.

The proposal includes a major financial bailout, changes to the benefit offerings and contract requirements, and a revamp to the committee that oversees program reform.

Let’s take a look at the proposal details so far.

$260 Million Bailout

In his final keynote address at the 2025 New Jersey League of Municipalities conference, Governor Phil Murphy laid out a $260 million plan to stabilize the SHBP-LG, with the general expectation that it will allow for a rate reduction in early 2026. The funds would be allocated as follows:

    • • $180 million towards loan forgiveness for past unpaid claims.

    • • $80 million to replenish the already depleted Claims Stabilization Reserve.

Structural Reforms to Coverage

On top of the proposed bailout, there is also a push to change how the SHBP program works and is administered. This would include:

    • • A dramatic dip in the number of health plan options offered.

    • • Limitations set on all offered prescription plans, including a 3-tiered exclusionary formulary (consistent with the NJEHP and GSHP) — plus higher copays, mandatory generic, and separate copays for specialty and weight loss meds.

    • • Likely cost shift, with more costs to employees. For example:

      • ▫ Primary care copays could triple (from $10 to $30).
      • ▫ Emergency room copays could rise (from $75 to $300).
      • ▫ Deductibles would go up sharply. Under the PPO: $2,500 in-network, $5,000 out-of-network.

    • • Proposed “stay-in” and “stay-out” requirements: local governments would be required to stay enrolled for at least five years, and if they choose to leave, will be locked out for five years.

New Oversight Structure

To prevent the governance issues that have bogged down reform efforts in the past, Murphy’s proposal would create a seven-member commission, with representation from municipal employers and employees replacing the old 12-member panel.

Public Reactions

While this proposal has only just become public knowledge following the League of Municipalities Conference, it is already being met with resistance. Union leaders are amongst the most outspoken critics. The CWA (Communications Workers of America) has called the proposal a “non-starter,” arguing it shifts too much cost to workers and weakens benefits. Meanwhile AFSCME (American Federation of State, County, and Municipal Employees) has also blasted the plan, with its executive director calling it “an insurance executive dream.” And one labor leader framed the state’s approach as failing to address root cost drivers, like hospital pricing and drug costs.

As the conditions of the bailout progress and the question of whether the SHBP will still exist in 2026 looms, Benecard will stay connected to all developments and continue to keep our readers updated. If you have questions, please email us at talktous@benecard.com.


Sources:

SHBP-Local Government’s Financial Crisis – Benecard
State Health Benefits Program broke: Murphy proposes $260M bailout – nj.com
https://www.nj.gov/governor/news/news/562025/approved/20251120b.shtml
https://newjerseymonitor.com/2025/11/20/governor-murphy-state-health-benefits/
https://www.lawyer-monthly.com/2025/11/n-j-s-public-worker-health-plan-is-broke-and-murphys-260m-bailout-could-trigger-the-biggest-benefits-fight-in-a-decade/
https://patch.com/new-jersey/across-nj/njs-state-health-benefits-plan-death-spiral-murphy-proposes-260m-fix
https://nj.gov/governor/SHBPProposedLegislation.pdf
https://njbmagazine.com/njb-news-now/murphy-announces-plans-to-reform-public-worker-health-plan-system/

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Update: Trump Administration Moves Forward with Tariffs on Imported Drugs

by Rx Insights

On September 25, 2025, President Trump announced plans to impose a 100 percent tariff, effective October 1, on branded or patented pharmaceutical products imported into the United States unless manufacturers are already “building” a domestic facility.¹ While the announcement captured widespread attention, recent reporting suggests that enforcement could be delayed, selectively applied, or even paused altogether as the administration finalizes exemption criteria and navigates political and legal challenges.²

What It Means for Plan Sponsors

At this stage, the proposed tariffs have no direct impact on pricing or supply. Potential effects will depend heavily on how exemptions are defined and implemented. Drug costs could rise modestly if manufacturers pass through tariff-related expenses or if domestic production proves more expensive than overseas manufacturing. Supply chain risks remain a consideration for therapies with limited domestic capacity, though wholesalers report stable inventories and no immediate disruptions.

Outlook & Next Steps

Many implementation details are still being developed, including whether tariffs will apply to finished products or active ingredients and which product classes may ultimately be affected. Stakeholders across the pharmaceutical industry are lobbying heavily, and political, legal, or logistical challenges could shape how the tariffs are ultimately applied.3 Industry experts expect additional guidance in the coming weeks as agencies refine rulemaking and consider exemptions for essential medicines.

For now, no immediate action is required from plan sponsors and brokers. Given ample inventories, high generic utilization, and the likelihood of broad exemptions on many brand name drugs, the near-term risk to pricing increases related solely to tariffs appears highly unlikely. We will continue to monitor developments closely and update our brokers and clients as the policy landscape evolves.

Sources:

1https://www.cnbc.com/2025/09/26/us-to-impose-100percent-tariff-on-branded-patented-drugs-unless-firms-build-plants-locally-trump-says.html

2https://www.pharmacypracticenews.com/Policy/Article/10-25/Trump-Truth-Social-Tariff-Announcement/78429

3Trump drug tariff draws backlash from NJ pharma industry – NJBIZ

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NJ SHBP Plan Design Committee Approves Prescription Copay Changes for Local Government Plans

by Rx Insights

Please note that this article was originally published on 10/01/2025 and updated on 10/03/2025 after the Benecard Team received further guidance from the State.

On September 24, 2025, the NJ SHBP Plan Design Committee (PDC) met and approved several changes to the prescription drug plans for the State Health Benefits Program – Local Government (SHBP-LG).

Key Updates

The following changes apply to all State and SHBP-LG prescription plans, including MMRx and with the exception of the HD High Plan which was not referenced in the resolution. It is also important to note that these changes only apply to active employees. There were no changes to the early retirees or Medicare-eligible retirees.

Effective November 1, 2025, non-diabetic GLP-1 drugs prescribed for weight loss will carry a $45 copay per 30-day supply until the State implements a lifestyle management program. Once the program is active, members who participate will continue paying the $45 copay, while those who do not participate in a lifestyle management program will see their copay rise to $125 per 30-day supply.

The SHBP-LG will introduce the following copay structure which is now expected to become effective on July 1st, 2026:

● Generic drugs: $10 retail (per 30-day supply) / $10 mail order (90-day supply)
● Preferred brand drugs: $20 retail (per 30-day supply) / $50 mail order (90-day supply)
● Non-preferred brand drugs: $75 retail (per 30-day supply) / $150 mail order (90-day supply)
● Specialty drugs: $75 (available through mail order only, up to a 30-day supply)

In addition, mail order will become mandatory for all maintenance drugs. The resolution also sets new out-of-pocket maximums for prescription drug benefits: $2,120 for individuals and $4,240 for families. All other prescription benefits remain unchanged—such as mandatory generic, mandatory mail order for specialty drugs, step therapy, and an exclusionary formulary. 

As of now, the above plan changes do not come with any rate reduction off the double-digit premium increases for 2026 which were approved in early September.

This remains a fluid situation. Benecard will continue to closely monitor this ongoing situation and keep you updated on any further developments or communications related to the NJ SHBP-LG. In the meantime, if you have any questions on this topic, please email us at talktous@benecard.com.


Sources:
SHBP PDC RESOLUTION #2025-11

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Protecting Plan Sponsors from Excessive Cost Risks

by Rx Insights

Prescription drug costs are one of the fastest-growing¹ and most unpredictable components of employer-sponsored health plans. A single high-cost therapy or catastrophic claimant can skew an entire year’s budget, disrupt cash flow, and destabilize long-term benefit strategies. Just 1% of employees account for nearly a third of all health care spending, averaging more than $206,000 per person annually1.

The Challenge with Self-Funding

Self-funding is often viewed as a cost-saving strategy because PBMs “promise” savings through manufacturer rebates, drug discounts, and clinical management programs. On the surface, these look attractive, but the actual savings or expected claim costs these PBM’s propose are not guarantees.

Let’s get right to rebates which typically become the primary selling point under self-funding.  Unlike our fixed rate program, where rebates are accounted for in month one and floated by Benecard, self-funded PBM’s typically don’t pay such rebates until 120–150 days after the close of each contractual year’s quarter—resulting in cash-flow challenges and budget uncertainty.

Prescription drug costs are especially vulnerable to excessive spikes in claims costs—often driven by one or two specialty drugs such as those related to oncology2 or inflammatory conditions, as well as weight-loss and diabetes drugs like GLP-1s. Stop-loss coverage may appear to offer protection, but it is not a silver bullet for managing 100% of the pharmacy risk. Plan sponsors remain exposed to exclusions through “laser” provisions, gaps in coverage, and additional costs beyond the stop loss insurance. Furthermore, after a poor claims year, it can become difficult to find a stop-loss underwriter willing to take on the risk.

The Benecard Guarantee: Combining the Best of Insured and Self-Funding

Benecard’s fixed-rate Rx benefit program is designed to break this cycle. Unlike self-funding, our model eliminates volatility by guaranteeing plan sponsors’ Rx bottom line and providing them with a fixed monthly rate for prescription drug coverage. That means:

  • ● No surprises: Plan sponsors know exactly what their Rx benefit costs will be, regardless of claimant mix or catastrophic prescriptions. There is no year-end reconciliation or unexpected supplemental payments required.
  • ● Budget certainty: CFOs and HR leaders can plan with confidence, free from the uncertainty of fluctuating claims experience.
  • ● Risk removal: The risk of one or two high-cost claimants derailing the plan is transferred away from the plan sponsors, creating true protection. There are no laser provisions or mandatory benefits that a plan sponsor is required to adopt.
  • ● Return of Savings: When plan performance is better than projected, plan sponsors receive a credit toward their renewal program costs—ensuring they benefit from favorable claims experience.

Leveraging Collectives to Spread Risk

Another strength of Benecard’s approach is the administration of collectives (groups of employers who share the risk together). By combining purchasing power and spreading risk across a broader population, collectives create stability that individual employers, particularly smaller ones, cannot achieve on their own.

Collectives help reduce the impact of catastrophic claims and ensure that no single employer bears disproportionate financial burden. For brokers advising clients, collectives are a powerful option to recommend, particularly for small to mid-sized employers who want the advantages of self-funding without the inherent risks.

A Smarter Path Forward

For plan sponsors, the choice is not just about funding models; it’s about risk management, predictability, and long-term sustainability. As brokers and consultants look for innovative ways to support their clients, and as plan sponsors seek to balance rising costs with competitive benefit offerings, fixed-rate Rx and collective solutions deliver precisely what today’s plan sponsors need: stability, protection, and guarantees.

To learn how Benecard’s fixed-rate Rx solutions can safeguard your Rx benefit plans, we invite you to connect with us and explore a smarter path forward. Email us at talktous@benecard.com to get started.

Sources:

1 “Just 1% of employees drive nearly a third of all health care spending”, BenefitsPro
2 “86% of employers increased cancer care spend since last year”, BenefitsPro

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Update: NJ SHBP & SEHBP Commissions Approve 2026 Rate Increases

by Rx Insights

Both the State Health Benefits Commission (SHBC) and the School Employees’ Health Benefits Commission (SEHBC) officially approved AON’s recommended premium increases for 2026. These approvals follow special hearings held last week, which members of the Benecard team attended to stay at the forefront of developments affecting our industry.

Key Takeaways from the Hearings

In July, we reported on the recommended premium increases from AON, the actuary for the State of New Jersey. With last week’s approvals, those recommendations are now official:

SHBP – Local Government:
+32.7% medical
+62.9% prescription		SEHBP – School Boards:
+27.9% medical
+58.6% prescription

In addition, both commissions discussed the possibility of implementing plan design changes for medical and Rx as early as 2026. While the scope and timing remain undetermined, this introduces new uncertainty for groups still in the State plans.

What This Means for Plan Sponsors 

For plan sponsors, the message is clear: while the 2026 increases are now official, the uncertainty surrounding benefit design introduces another layer of risk. Local government and school board groups already face unsustainable premiums, and the possibility of mid-year changes only heightens the need to consider alternatives. Benecard can offer full risk protection and/or access to trusts or group purchasing organizations, providing greater stability and predictability. Moving sooner rather than later may help employers avoid the brunt of escalating costs and unpredictable plan design shifts.

Next Steps

Plan sponsors should review their most recent claims experience and census with their broker and obtain accurate quotes from private carriers.

If you are currently contracted with a broker, have them contact Richard Van Noord, Benecard’s Vice President of Sales, at (800) 734-9528 or talktous@benecard.com. If you do not have a broker, you can contact Richard directly to explore available solutions.

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GLP-1 Update: Eli Lilly’s Oral Tablet Orforglipron Targeting Market Launch in 2026

by Rx Insights

This update continues our ongoing GLP-1 intelligence series, helping you navigate the evolving pharmacy landscape. Following our recent updates on the oral GLP-1 pipeline and evolving market pressures, we now have concrete data from Eli Lilly’s orforglipron Phase 3 trial.

The Results: Promising But Nuanced

Eli Lilly announced last week that its oral GLP-1 drug, orforglipron, achieved 11.9% average weight loss in their 72-week study with the convenience of daily oral dosing and no dietary restrictions. However, tolerability challenges emerged with 10.3% of patients discontinuing due to side effects (vs. ~7% with current injections) and notable GI effects including nausea (34%) and vomiting (24%)1. With regulatory submission planned by end of 2025, we’re looking at a potential 2026 market launch. 

What This Means for Patient Care & Plan Management

The data reinforces that oral GLP-1s represent genuine clinical progress but also confirms that thoughtful benefit design remains essential. While there are approximately 8 million patients on injectable obesity and diabetes drugs, around 170 million could benefit from the oral form1. Plan sponsors should adopt proactive management strategies to handle utilization growth of this magnitude.

Benecard’s Balanced Approach Rather than blanket exclusions, we help clients implement clinically informed strategies that balance patient access with cost sustainability. Our comprehensive approach includes an array of benefit modeling scenarios such as including coverage of non-oral GLP-1’s for weight loss for those with clinically severe obesity, defined treatment parameters, proactive positioning for emerging oral formulations, and centralized management through Benecard Central Fill for enhanced oversight and manufacturer copay access.

Sources: 1cnbc.com/2025/08/07/eli-lilly-obesity-pill-weight-los-trial.html

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Prior Authorizations: Their Value & How We’re Making the Process Better

by Rx Insights

Recent headlines and industry surveys highlight a growing concern: navigating prior authorization is a significant challenge for patients, prescribers alike. Delays, administrative hurdles, and varying standards across health plans can complicate access to needed treatments. These headlines have sparked renewed scrutiny of a process that’s too often misunderstood and has prompted action at the highest levels — from federal agencies introducing new rules for faster, more transparent decisions, to congressional hearings calling for greater accountability.

At Benecard, we believe prior authorizations, which we refer to as “clinical reviews”, deserve a clear and balanced conversation. Yes, the system needs improvement. But clinical reviews also play a vital role. They help protect patients’ health and safety, ensuring they receive the most appropriate, safe, and effective care. They also ensure our employer plan sponsors pay for only those covered medications being used in accordance with FDA approved uses and/or supporting medical compendia.

WHY CLINICAL REVIEWS EXIST

There are over 20,000 prescription drugs on the market today, each with evolving FDA-approved uses, off-label applications, changing safety warnings, and potential interaction risks. This makes it impossible for prescribers to track every detail for every patient, especially when a patient sees multiple prescribers or has a complex treatment plan.

Clinical reviews address this gap by consolidating prescription information into a single system, enabling PBMs to identify and report key risks such as harmful drug interactions, duplicate therapies, and new safety concerns that may not be visible to a prescriber. This is not about questioning a prescriber’s expertise. It’s about supporting them with additional safeguards to ensure the clinical appropriateness, safety, and effectiveness of medications before they are approved and dispensed to the patient. Want to see a real-world example of how this works? Click the link below to read our case study which demonstrates why clinical reviews are essential for patient safety.

DOWNLOAD THE CASE STUDY

BENECARD’S COMMITMENT TO BETTER CARE & LESS RED TAPE

At Benecard, clinical reviews aren’t just an administrative checkbox; they are a critical safety net to make sure each patient receives the right drug, in the right dosage and quantity, at the right time.

Our patient-first philosophy focuses on protecting members and plan sponsors by ensuring safe and appropriate use of prescription medications. While cost savings often follow from these safeguards, clinical oversight of the patient’s safety is always our top priority.

One of the biggest frustrations we hear from members with prior authorizations is the waiting — not knowing where things stand, when a decision will be made or having to go through the process for the same drugs on a routine basis. We have invested heavily in technology and service enhancements to reduce friction, improve communication, speed up decisions and extend the approval duration:

  • Electronic Prior Authorizations (ePA) through CoverMyMeds for faster, more accurate submissions and reduced back-and-forth paperwork with the prescribers.
  • Real-time status tracking via our Member Web Portal so members have detailed insight into the status of their clinical review.
  • 24/7 Member Services for questions, support, emergency and expedited requests.
  • Extended approval durations of clinical reviews, with approvals lasting from 1 to 3 years depending on the therapies and clinical appropriateness.
  • Care Coordination Program offered through optional enrollment to members we identify with multiple medications across different therapeutic classes. This program delivers personalized guidance through the prior authorization process and education about their coverage options.

Sources:

Americans say prior authorizations are a major problem, insurers vow to reduce burden

https://www.benefitspro.com/2025/06/23/health-insurers-promise-rfk-jr-theyll-fix-prior-authorization-problems

https://www.benefitspro.com/2024/12/12/transforming-prior-authorization-what-benefits-professionals-need-to-know-for-2025