PBMs Make a Case for the GLP-1 Teeter Totter: Up on the Pharmacy Benefit, Down on the Medical One | AMCP Nexus 2025

The glucagon-like peptide 1 (GLP-1) drugs stand to be a huge burden on pharmacy benefit budgets of health plans, but for those who need to mind healthcare costs, the hope is that spending on obesity-related health problems will decrease.

“It really behooves the PBMs [pharmacy benefit managers] to say, ‘Let’s look at the patient as a whole,’” said Jennifer Cruz, Pharm.D., a pharmacy benefits consultant for Milliman, in an interview with Managed Healthcare Executive.

The PBMs are doing to say, Cruz continued, “we’re going to show you where you saved money over here by reduced hospitalizations, weight loss and reduced comorbidities, because we're not going to decrease your drug spend with the GLP-1s.”

Cruz was a panelist at a session about PBM and health plan contracting at the AMCP Nexus meeting held in National Harbor, Maryland.

Cruz says GLP-1s — and diabetes management in general— are an area where pharmacy benefit managers and health plans are negotiating value-based contracts that take into account both the pharmacy and medical benefits and how increased spending under the pharmacy benefit may be offset by decreased spending on the medical.

The value-based contracts tend to be layered on to other contracts, Cruz explained. The PBM and health plan may agree on an outcome — Cruz gave hospitalizations related to diabetes as an example — and then terms whereby the health plan and PBM share the risk.