Don Anderson, Pharm.D., on tying GLP-1 coverage to wellness plan participation | PBMI 2026

An employer plan that tied GLP-1 coverage to mandatory participation in wellness coaching saw a notable drop in members’ body mass index along with signals of savings on both the medical and pharmacy benefits, according to Don Anderson, Pharm.D., vice president of OrionRx, a pharmacy benefit manager headquartered in Irvine, California.

When OrionRx onboarded the employer, the client made clear it wanted to cover glucagon-like peptide 1 (GLP-1) drugs for weight loss but wanted to spend the money effectively given the high monthly cost per member, Anderson said in an interview last week with Managed Healthcare Executive at the 2026 Pharmacy Benefit Management Institute Annual National Conference in Orlando, Florida. OrionRx designed the benefit so that GLP-1 claims are covered at the pharmacy point of sale only if the member is actively participating in a health and wellness program, which Anderson consists of monthly phone call. “They're going through with our dieticians and with our nurse coaches what their health status is, what they're doing,” Anderson said.

Anderson described the design as more of a “stick” than a “carrot” approach. “It’s really forcing them to participate [in the health and wellness program] for access [to the GLP-1 prescription],” he said.

The results came faster than expected, Anderson said. The participating population’s average BMI fell about six points within a single calendar year, moving from approximately 38 down to 33. OrionRx is now examining medical claims for that population to quantify savings tied to the weight reduction and expects a fuller picture once a full year of data is captured. The plan has already seen savings on the pharmacy side, Anderson said, because improved GLP-1 effectiveness has reduced many members' use of diabetes medications.

Anderson said the biggest surprise wasn't a clinical or financial one — it was the improvement in members’ job satisfaction and overall life satisfaction as their weight declined, a behavioral and emotional benefit that hadn't been anticipated.