We’ve been pitching employee education on weight loss drugs all year. Obviously we’re enjoying some success, or we wouldn’t keep doing it, right?
Alas, “some success” does not mean “complete success.” Yet we should be enjoying complete success, because the ROI of “dissuading the GLP-curious and educating the GLP-serious” is obvious:
Most users – largely the GLP-curious – drop out after months of spending $3000+ of your dollars.
Our Before Your Journey quiz costs a tiny fraction of that…and you pay only for those who we dissuade. Those we don't dissuade get access to our entire "GLP-serious" curriculum gratis.
You may recall these stats from our webinar last month, from the Blue Cross Association and Reuters:
Anyone in the 30%, and most in the 58%/64% drop out "before seeing a clinical benefit."
The Quizzify solution is, as described in previous posts and webinars, to gate the drugs with our 27-question Before Your Journey quiz. Questions like these two ensure only those who are truly committed to improving their health will continue – saving you thousands in wasted drugspend on the 64% who drop out.
And just so there is no gender discrimination...
So why doesn’t every employer sign up for this? "Gating" can be harder than one would think, for two reasons.
First, the major PBMs refuse to allow education to be part of their preauthorization. This despite the facts that:
Diet education is listed right on the FDA insert as an adjunct therapy (technically, the drugs themselves are the adjunct therapy to diet and exercise);
Standard preauthorization incorrectly assumes people won’t binge their way to the threshold BMI, making preauthorization at best a partial solution.
They feel very strongly about this. There might even be a clause in your contract prohibiting you from doing preauthorization.
Second, consider the dilemma of the other PBMs, those in what we call the “integrity segment” of the market. They are more than happy to participate with us (and several already are), but they have warned employers that the drug companies might take away their rebates if they find out that employee education – which is possibly even an ERISA fiduciary requirement for you given what the FDA insert says – is part of the preauthorization.
Conclusion: incorporating employee education directly into the preauth might risk the wrath of either the PBMs or the manufacturers. Their fiduciary obligation is to their shareholders, not you.
What to do instead?
Let us recall the immortal words of the great philosopher Buckminster Fuller:
You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.
And we can do exactly that: circumvent the existing reality without disturbing it: Both with the honest, transparent PBMs in the "integrity segment," and with the others.
You can offer Quizzify’s Before Your Journey quiz as part of your existing incentive program, rather than getting involved with the PBM or preauth at all. Here are the five reasons that make this approach the "glide path" mentioned above:
The major PBMs can’t object because even their most massive, comprehensive contracts don’t restrict your wellness incentive program at all. (This assumes they even know you have a wellness incentive program.)
“Transparent PBMs” will gladly support this process. Contact us for a list of those who we are already contracted with.
You avoid any logistical hurdles in coordinating with the PBM, pharmacy, physician or navigator as part of their preauthorization.
Implementing this quiz is easy – no PHI or “data dumps” are required.
Adding an option to your incentive program is easy. And you can load points/dollars/points into this option because, uniquely among your incentivized initiatives, you get an immediate payback probably half the time this quiz is taken.
As to the last observation, you might ask: “What about the other half the time? What about people with no intention of using these drugs taking this quiz just to get the incentive?” Two answers to that:
The economics are such that even if you quite literally give everyone who takes the quiz $100, your $3000+ savings on the 30%+ of quiz-takers who are GLP-curious would overwhelm your incentives to non-indicated employees.
Those enterprising employees would find some other way to earn their annual incentive.
This glide path will not be the solution for every group (since some groups don't have incentive programs), but adding this one to the menu of all our other solutions will certainly provide a full range of options for every group. It will be a rare group that doesn't find something on this list to help them "dissuade the GLP-curious and educate the GLP-serious," which is the optimal segmentation for weight loss drug coverage.
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