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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

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

Recent headlines highlighted the Trump administration may be threatening to impose steep tariffs, potentially as high as 200%¹, on imported prescription drugs. This is part of a broader initiative to reshore pharmaceutical manufacturing to the United States.

While this may sound alarming, there is no immediate cause for concern. At this time, these tariffs have not yet been enacted and, according to both Commerce Secretary Lutnick and President Trump’s statements, any tariff changes would not take effect for at least 12 to 18 months. This would place the possible implementation window between the latter half of 2026 or beginning of 2027. More details are expected to be forthcoming from the Trump administration.

The Benecard team is actively monitoring this development and we will continue to keep our healthcare professionals and plan sponsors apprised of any tariff policy announcements or news related to this matter from the Trump administration.

Ready to discuss how these strategies can work for your clients?

Contact us today at (800) 734-9528 or talktous@benecard.com to discuss how Benecard is helping employers tackle rising drug trends.

Sources: 

¹200% drug tariffs loom as Trump pushes reshoring of pharma manufacturing

Last week, AON presented its recommended 2026 premium increases to the State Health Benefits Commission (SHBC) and the School Employees’ Health Benefits Commission (SEHBC) — and the numbers are substantial for both medical and Rx premiums:

SHBP – Local Government:

• +32.7% medical
• +62.9% prescription
• View rate setting analysis report (SHBP)

SEHBP – School Boards:

• +27.9% medical
• +58.6% prescription
• View rate setting analysis report (SEHBP)

These increases are still recommendations and are not yet finalized, but they reflect the ongoing financial instability in these plans which are consistent with the recent NJ State Department of Treasury report (see our recent article in case you missed it). We will continue to actively monitor this situation and will update you as soon as the SHBC and SEHBC vote on the final 2026 rates.

In the meantime, if your public sector clients are enrolled in the SHBP or SEHBP, now is the time to start evaluating alternative options. In this volatile market, Benecard’s fixed-rate prescription benefit model can offer greater predictability and stability.

Contact us today at (800) 734-9528 or talktous@benecard.com to learn more about our unique prescription benefit solutions.

The GLP-1 landscape continues to evolve rapidly, with new data revealing both expanding employer coverage and intensifying financial pressures. As we’ve highlighted in our ongoing GLP-1 series, understanding these trends, and implementing proactive management strategies, has never been more crucial for plan sponsors.

THE CURRENT MARKET REALITY

Recent data reveals a dramatic shift: 36% of employers now provide GLP-1 coverage for both weight loss and diabetes (1). While this reflects growing recognition of these medications’ value, it comes with serious cost implications. The use of GLP-1 drugs for weight loss currently represents 10.5% of total claims, and 27% of employers report GLP-1 drugs account for more than 15% of their annual drug spend (1). With oral formulations approaching FDA approval, the trend is accelerating.

HOW EMPLOYERS ARE RESPONDING

Faced with these unprecedented cost pressures, more than three-quarters of employers now employ cost-control mechanisms (1), including:

• Prior authorization requirements (96% of employers using utilization management)
• Strict eligibility criteria focusing on clinical severity (68% of employers)
• BMI thresholds and comorbidity requirements (88% require minimum BMI; 60% require obesity plus chronic conditions)

BENECARD’S COMPREHENSIVE GLP-1 SOLUTIONS 

Benecard has developed targeted benefit design features to help reduce the rising costs associated with brand-name GLP-1 drugs prescribed for weight loss while ensuring appropriate clinical care:

• Clinical Severity Targeting: Limiting weight loss coverage to patients who are qualified as having clinically severe obesity (BMI ≥40 or BMI ≥35 with comorbidities) who face the highest medical cost risks.
• Defined Treatment Length: Limiting all current, future, and any combination of oral and non-oral weight loss GLP-1 drugs to twelve fills each at a 30-day supply for a lifetime maximum per member.
• Proactive Market Positioning: Excluding coverage for upcoming oral GLP-1 tablets approved for weight loss and/or for diabetes treatment.
• Centralized Management: Requiring all brand-name injectable GLP-1s to be filled through Benecard Central Fill (BCF) for enhanced clinical oversight, improved cost control, and access to manufacturer copay assistance programs. 

PREPARING FOR CONTINUED EVOLUTION

Plan sponsors implementing structured GLP-1 management today position themselves for long-term sustainability as this market continues to expand. Our fixed-rate Rx benefit solution provides the predictability you need while our innovative benefit designs help control utilization without compromising quality care.

Ready to discuss how these strategies can work for your clients?

Contact us today at (800) 734-9528 or talktous@benecard.com to explore customized GLP-1 management solutions.

The weight loss drug market is evolving rapidly as pharmaceutical companies advance their clinical trials for both oral and non-oral GLP-1 formulations. As Biopharmadive recently noted in an article, “The obesity drug race is far from over, with a plethora of companies vying for a piece of what’s expected to become a huge market in the years ahead. Analysts project that “incretin” drugs, like Novo’s Wegovy and Lilly’s Zepbound, could top more than $100 billion in yearly sales by 2030.” 

While these emerging treatments promise expanded therapeutic benefits for obesity-related conditions as well as improved efficiency in weight loss, they also pose challenges for employer-sponsored prescription plans already experiencing unprecedented utilization and cost increases from GLP-1s.  

Emerging Treatments in Clinical Trials 

These pharmaceutical companies are conducting extensive clinical trials for both oral and non-oral GLP-1 drugs, with each potential treatment still awaiting FDA approval: 

• Novo Nordisk’s experimental oral drug, amycretin, currently in Phase 3 trials, has shown promise beyond weight loss. By targeting both GLP-1 and amylin receptors, it may offer additional benefits for cardiovascular health and metabolic disorders associated with obesity¹.  

• Eli Lilly’s orforglipron, advancing through Phase 3 trials, demonstrates potential benefits for obesity-related complications including fatty liver disease and sleep apnea².  

• Amgen’s MariTide (maridebart cafraglutide), in late-stage clinical trials, is being studied for potential impacts on obesity-related inflammation and metabolic syndrome, with a unique monthly dosing approach³.  

• Other pharmaceutical companies, including Roche and emerging biotech firms, are conducting trials focusing on broader therapeutic applications for obesity-related conditions while improving tolerability⁴.  

The Implications for Plan Sponsors 

As these medications progress through clinical trials toward potential FDA approval, many current injectable users may transition to oral versions, while the improved accessibility could drive new patient adoption. This shift will likely intensify the financial pressure on prescription benefit plans. 

In response to these market dynamics, Benecard continues to develop innovative solutions to help manage rising costs of GLP-1 drugs while ensuring appropriate care. Our comprehensive approach includes specialized plan design features which were previously addressed in our three-part bulletin series “decoding the rising Rx trends.” 

Contact us to explore strategies for managing GLP-1 medication expenses while supporting employee health outcomes. 

Sources: 

“The Race for Oral Obesity Drugs: Multiple Phase 3 Trials Vying for Next-Gen Status,” Fierce Pharma. 

“GLP-1 Market Heats Up as Companies Vie for Next-Gen Obesity Drugs,” Outsourcing-Pharma. 

“Why Amgen’s MariTide Could Rival Eli Lilly and Novo Nordisk’s Obesity Drugs,” Business Today. 

“Four Oral GLP-1 Products in Phase III Trials as Race Intensifies,” Clinical Trials Arena. 

In today’s market if you’re seeing prescription drug trend estimates in the single digits, you should know: those numbers don’t reflect reality. Some trend calculations may focus solely on manufacturer drug price inflation and therefore dramatically understate actual or true prescription benefit trends. To accurately project trends, additional critical factors must be considered:

• Utilization Patterns – Prescription volume increases yearly as population age and chronic conditions become more prevalent and members simultaneously shift to newer, costlier alternatives. Medical advancements allow for earlier diagnosis which drives longer treatment duration and higher utilization.
• Specialty and Non-Specialty Pipeline Impact – New to market drugs typically launch at premium price points as compared to existing products. These treatments often expand the treatable population while commanding unprecedented costs.

The Risk of Underestimating

When these factors are properly weighted, we consistently see trends in the mid to higher teens. When plans understate drug trends, they create severe budget shortfalls. This forces employers to make radical mid-year plan design adjustments or significantly increase contributions or benefit reductions the following year, all while making it increasingly difficult to secure stop-loss coverage in the following year without significant rate increases. 

Looking Ahead

While we can’t control drug prices, we can control how benefits are managed. That’s where Benecard Services is different. Instead of just chasing rebates and managing unit costs, we have aligned financial interests with our clients that focus on getting members the right medications while keeping costs in check. No conflicts of interest ― just patient-centered care that works.

With more specialty and GLP-1 drugs in the pipeline, these trends will only intensify. Contact us today at (800) 734-9528 or talktous@benecard.com to discuss how Benecard is helping employers tackle rising drug trends.