The picture

GLP-1 trend pressure is the dominant pharmacy-benefit budget question of 2025-2027. PMPM impact of $8-15 in year one is now standard. Sustainable strategies: (1) defined-contribution model — plan covers a fixed dollar amount per month, member pays delta to manufacturer direct (NovoCare $499/mo, LillyDirect $349-499/mo), gives members the same benefit at predictable plan cost; (2) outcomes-based contracts with manufacturers — pay-for-performance based on documented weight loss; (3) integrated lifestyle-program partnerships (Calibrate, WW Med+) that bundle GLP-1 with behavioral support and share data; (4) renewal benchmarks that prevent indefinite high-cost use.

Key statistics

Year-1 PMPM impact (open access)

$8-15

Year-1 PMPM impact (defined contribution)

$4-7

Behavioral-program-bundled outcomes (weight loss vs medication-only)

+17-24%

Per-member medical savings (post-weight-loss, year 3)

$1,200-2,800

Takeaways

Defined-contribution model is the cleanest cost-control lever — predictable for plan, no access restriction for member.
Outcomes-based manufacturer contracts are increasingly negotiable; ask your PBM.
Behavioral-program bundling improves outcomes 17-24% per Calibrate 4-year dataset.
Year-3 medical cost reductions partially offset pharmacy cost. Track total cost of care, not just Rx PMPM.
Never cap lifetime supply — adverse selection drives high-needs members to other plans.

GLP-1 cost-control strategies

GLP-1 cost-control strategies