An SGLT2 Trial Before GLP-1s | PBMI 2025

The surge in prescriptions for glucagon-like peptide 1 (GLP-1) drugs has blown up pharmacy benefit management (PBM) company budgets. PBMs have responded in several ways. At the 2025 Pharmacy Benefit Management Institute Annual National Conference last week, Jennie Barlow, Pharm.D., MBA, described one of the tactics that Scripius is using to contain the cost.

Scripius is a PBM owned and operated by the Intermountain Health health system in Salt Lake City, Utah, and Barlow is an associate vice president, pharmacy industry relations, for the PBM.

Barlow said Scripius has multiple GLP-1 contracts when the drugs are used for treatment for Type 2 diabetes. One includes a 90-day trial with sodium-glucose cotransporter-2 (SGLT2) inhibitor before access to GLP-1 coverage is granted. Failure on the SGLT2 inhibitor is defined as still having a hemoglobin A_1C greater than 7.0 after 90 days on an SGLT2 inhibitor, a class that includes Brenzavvy (bexagliflozin), Farxiga (dapagliflozin) and several other brands (generic versions are available).

According to Barlow, 35% to 40% of people who go through the SGLT2 trial first do not need to transition to a GLP-1 because they are able to achieve blood sugar control with an SGLT2 inhibitor.