Lilly recently announced the launch of LillyDirect, a digital healthcare experience for patients living with obesity, migraine, or diabetes. Positioned as a connection to care, LillyDirect connects patients to telehealth resources, in-person care, and pharmacy services while also providing disease state and educational healthcare information to support patients. LillyDirect is a first for a manufacturer to facilitate direct-to-consumer access to medications and healthcare services.
Many of the headlines associated with the launch of LillyDirect revolve around Lilly’s recently approved weight loss medication, Zepbound. Zepbound is part of the GLP-1 class of medications, which also includes the weight loss medication Wegovy and diabetic medications Mounjaro and Ozempic.
GLP-1s have seen a significant increase in demand over the last year driven by effectiveness at lowering a key metric for diabetic control (HemoglobinA1C) and the resulting weight loss patients on GLP-1s have experienced. Demand for GLP-1s created shortages throughout 2023, limiting some utilization. Even with the shortages, GLP-1s have been a major cost driver for plan sponsors, and PBMs have indicated that GLP-1s account for approximately 25% of the total prior authorization volume. In addition to Zepbound, Lilly insulin, as well as Lilly’s preventive migraine medication Emgality, are also included in the LillyDirect program. Interestingly, Mounjaro does not appear to be part of the LillyDirect program at this time.
As part of the pharmacy services offered through LillyDirect, prescribed medications can be provided directly to patients through home delivery, manufacturer savings can be integrated into the transaction, and prior authorization services will be coordinated. Increased accessibility can come with an increase in demand and a resulting increase in costs to plan sponsors. Reviewing the coverage intent of weight loss medications as well as the availability of utilization management strategies for Emgality (CGRP inhibitors) and GLP-1s can be an effective strategy to ensure appropriate utilization of these medications.
What’s Next?
Account teams and clients should review coverage intent of weight loss medications as well as UM programs available for CGRP inhibitors and all GLP-1s (diabetic and weight loss) if they haven’t already done so.
Dr. Jeff Eichholz is the Director of Pharmacy Solutions for McGohan Brabender. If you have a question or topic you would like addressed, you can email him at jeichholz@mbbenefits.com.