Elevance Health's PBM Offers Weight-Loss Program to Self-Insured Employers

CarelonRx, the pharmacy benefit manager for Elevance Health, announced that it will launch a digital weight management program for its self-insured customers this spring, joining the list of payers looking for ways to cope with the escalating demand for weight loss services fueled by the popularity of the GLP-1 drugs, Wegovy (semaglutide) and Zepbound (tirzepatide).

The company said yesterday that participation in the program will not be required for a GLP-1 prescription and that clients will be able to offer the program independently from coverage of Wegovy and Zepbound.

“At CarelonRx, we want to ease the complexities of weight loss and weight management and support healthier lifestyles for our members,” said Paul Marchetti, MBA, president of the CarelonRx, said in the news release today about the program.

Anthem changed its name to Elevance Health in 2022.

The combination of the FDA approval of Wegovy and Zepbound and the large swathe (approximately 40%) of the U.S. population that has obesity has powered an unprecedent demand for weight loss services. Some employers, such as the University of Texas, have cut off coverage of the GLP-1s as the cost of covering drugs skyrocketed. Others have expressed in interest in programs like the one that CarelonRx is offering.

The news release about the program says it will have digital coaching and wellness tools but also “human support — both digitally or over the phone — whenever needed.”

In response to emailed questions from Managed Healthcare Executive, the company said the digital aspect of the program is organized into modules for lifestyle management, GLP-1 use and management by clinician and maintenance, to help members keep weight off.

CarelonRx has access to electronic health record data and “all engagement data, including demographics, activity level, and program status captured through the weight management program” the company said in an email. The engagement data captured through the weight loss program will be included in the members’ digital dashboard and will be accessible to case managers, health coaches and pharmacists, the email said.