Emerging Pharmacy and Managed Care Trends

Hello, everyone.

Employers are tasked with the responsibility of choosing the right pharmacy benefit manager for their organization to manage costs, ensure quality of care, and improve the health and well-being of their employees. On behalf of McGriff, I would like to take this opportunity to thank each of you for joining us today as we discuss emerging pharmacy and managed care trends. Today, we're gonna discuss the McGriff pharmacy consultant practice, emerging managing managed care trends, the GLP one drug outlook, and weight management programs. My name is Lasonya Wilder, and I will be the host for the call today.

There are just a couple of housekeeping points that I would like to share with you before we get started. This is a live session, and you are in listen mode only. If you have any questions at any time during the presentation, feel free to utilize the chat box or Q and A box to type in your questions and we will address them during the Q and A segment. If time doesn't permit us to answer the questions after the presentation, we will be sure to capture them and provide the responses afterwards.

So now it brings me great pleasure to introduce to you our panel of speakers for the hour. And we have with us Denise Cabrera.

She's the senior vice president, national pharmacy practice leader with McGriff. Denise is a doctor of pharmacy, earning her degree from the Ohio State University.

With over twenty five years experience, she brings broad aptitude in managed care. Denise's passion to influence quality of care and affordability in health care translates well as she leverages her experience to help employers achieve their strategic imperatives.

We also have Christine Diaquino. She's the as a director of the go to market strategy for Caroline prescription product. Christine is responsible for developing strategic planning and market insights to deliver innovative concepts and pricing strategies that meet the needs of clients and members.

Christine partners with stakeholders across CareLionRx and Elevent's Health to deliver an integrated whole patient care approach to pharmacy products. Christine has over seventeen years of experience in the health care industry with her primary focus being innovation and product management. We also have Mike Buss with over twenty five plus years personally in health care. He's excited to work with and partner with organizations that truly care about each individual member.

As a health care leader, Lark Health in partnership with CareLionRx, he takes on a holistic approach in helping each individual member to reach and retain their weight management health care goals. We also have with us Carmen Latham. She's the vice president of consultant relations with Caroline, as well as Matthew Moore. He's the RPH pharmacy clinical account director with the national accounts with Carillon.

So at this time, I would turn it over to Denise to kick off the presentation.

Thank you so much, Lasonya, and thank you all for joining us this afternoon to look at some of the ongoing and emerging pharmacy and managed care trends. As I was thinking through the trends over the last fifteen to twenty years, I was reminded that the ACA is now fifteen years old, initially launched in March of, twenty fifteen, and so we're looking at, or I'm sorry, twenty ten, so looking at fifteen years of trying to achieve what they referred to as the Triple Aim, improved quality of care, improved affordability, and population health. The Centers for Medicare and Medicaid Services still expect pharmacy drug spend to be the largest growing healthcare expenditure over the next decade.

This is estimated to really influence the cost of care, but also we know that improved quality outcomes are associated with getting folks on the right therapy, medications that treat and prevent progression of disease.

But it is unfortunately still one of the highest cost expenditures. In fact, CMS estimates that forty cents of every dollar spent on healthcare in the U. S. Is spent on drug therapy.

We've seen exceptional progress in therapies with digital therapy and chronic condition management with specialty medications that prevent progression of disease. We've seen very innovative therapies for rare orphan diseases especially around gene therapy.

You may have heard of Zolgensma that helps with the spinal muscular atrophy condition in children. It is life changing for them, but the Zolgensma treatment is also very expensive at about two point one million dollars There are other gene therapies for sickle cell anemia and there are about four hundred therapies in the pipeline. So this is an exceptional therapy. It is life changing and curative for generations but it does come with a very costly, price tag. So we'll continue to look for those types of therapies to improve population health overall.

We also have a lot of different, what I would refer to as point solutions, programs that help with behavior changes and wellness, and we're gonna have our partners from Carillon Rx talk a little bit more in detail about that.

One of the areas that we'll really focus on is the specialty drug management.

Specialty drugs, just as a, a bit of a reference point, are very large molecules. When you think about the molecule for Tylenol, if that looks like, an apple, we'll say, then the specialty drug looks like the whole tree. They're just very large biologic or from living tissue molecules and so they're very complex and you can imagine the research and development is very expensive and therefore these medications are priced at much higher unit costs.

We know that about one point five percent of claims and about one to two percent of members are driving fifty to sixty percent of pharmacy spend for clients across our book of business.

We do have, some insight into the disease modification lowering overall healthcare costs because obviously if you can better manage conditions like, like rheumatoid arthritis, colitis, Crohn's disease then these folks are healthier and of course it can mitigate some costs for medical resources.

There is also some cost relief with the biosimilars.

The biosimilars really have been, a possibility in the market for years, but we just saw the first launch of Amdivita in March of twenty twenty three, that's the biosimilar for Humira, and so that offered some cost relief. Most of the pharmacy benefit managers took a little bit of time to decide what they were going to do with their biosimilar strategy because there weren't too many that were interchangeable.

And that's something that's really important because when you have a biosimilar it's like the generic version of the specialty drug, but if it's not interchangeable then physicians had to actually write for the specific drug name. There are now more biosimilars. I believe there are ten for Humira and there are seven that are approved for Stelara which are launching this year. And so most of the pharmacy benefit managers do have a very strong biosimilar preference and with these interchangeable drugs we're going to start to see some real cost relief for these drugs.

Some of the key decisions that you would have to make as a plan sponsor are, you know, do you want to take an aggressive approach towards steering to the biosimilars?

Some of the things that you'll wanna be aware of and talk to your pharmacy benefit manager about are, you know, how will this impact the rebates, what is the net cost of these medications, is there any flexibility with respect to the strategy and the messaging to members and to prescribers.

So it's we're really, I think, just still in the beginning stages of really helping to promote these and leverage them for a cost of care type of reduction that we'll see going forward.

Moving on to another very important trend driver and this is something that most of our clients have asked quite a bit about.

We're gonna look a little bit at the diabetes drug costs and specifically the drug class referred to as GLP-one medications.

These are drugs that were initially prescribed for diabetes, drugs like Ozempic, and then these manufacturers very quickly learned that these medications could also help with weight loss, which is great.

And in the last five years, these medications have really had a tremendous effect on the efficacy of diabetic treatment as well as helping with weight loss.

There has been a bit of bad behavior, I would say, because there are some folks who maybe weren't diabetic and were trying to get the Ozepic, because that's what was covered under the plan. And so a lot of times plan sponsors have to put in some guardrails when that kind of behavior starts.

The reason I say that is because what you'll see here is the trend went up significantly, and while we know there are about thirty three to thirty five million Americans battling diabetes, type two diabetes primarily, we don't believe that it increased this significantly. And so I think these were some folks that maybe were either prediabetic or just, you know, really wanted to use these medications to help them in their weight loss journey. And so we did see an increase in utilization and costs that really out, out marched what we think the, the true diabetic population would have looked like.

And, we're gonna talk a little bit more in detail about that as we go further but just wanted to kind of take a look at some of the, some of the plans that employers are really looking for. This is, a study that was recently done by the business group on health in twenty twenty five.

Sixty two percent of large group employers are working with their current pharmacy benefit manager to think about more utilization management strategies, more ways to bring point solutions in to help manage population health, and forty percent of them are considering implementing some type of transparent pharmacy pricing module. So, I would say that, you know, in the past these statistics have been lower, maybe, I would say maybe forty to forty five percent of employers were willing to look at more structured or more, more utilization management strategies. So that's increased over time because of these types of dynamics where now more of the higher cost medications are being used to treat a chronic condition where there is a large population for, for instance, diabetes.

And so we're seeing more focus not only on the pricing but on the benefit design and the partnerships that employers can have, not only with their medical carrier and their pharmacy benefit manager, but other organizations that help manage the journey for patients specific to chronic conditions like diabetes.

So with that, I would like to turn it over to Matthew Moore, he's the clinical pharmacist with Carillon RX, one of our partners, and he's gonna go a little bit deeper into the market dynamics for the GLP one medications and also weight management solutions.

Hey. Thanks, Denise.

And, we go to the next slide here. It kinda illustrates, the obesity in United States. I pulled this slide together to kinda showcase the trends that we saw for obesity growth within the US population as a whole. And the graph kinda showcases from nineteen sixty all the way through two thousand eighteen. And you can see the light blue line is actually overweight individuals, where the dark blue line is actually obese individuals.

And you can see there's a cross point, roughly in the early two thousands where we saw more obesity patients rather than overweight individuals.

And you can kinda see that about forty three percent of the US population is classified currently as obese. There's three hundred and sixty two million individuals in the US, so it's about a hundred and fifty million individuals fit this particular category. So this is some of the rationale and reasoning for why this epidemic of obesity has grown, and it's kinda grown fairly quickly within the US population.

If we roll to the next slide here, what I try to illustrate here is some of the, GLP one condition indications. And GLP one's, is short for an acronym for glucagon like peptide one. It's a hormone that actually regulates blood sugar and appetite within the US within the body itself.

And you can see these have grown some, adoption in the US population by, physician prescribers, to write for, these individual agents. And the right hand side illustrates, you know, more of the common eight products you'll find, that most individuals have actually seen prescriptions for. The products themselves originally were indicated for treating type two diabetics, and, you saw the majority of individuals being written prescriptions for Ozempic and and Manjaro are kind of the leading two products for type two diabetes treatment. And then you've also seen GLP ones have some of the positive effects of weight loss as well. Right? That was one of the side effects of being in these products themselves originally when they were studied. And newer products that have emerged, that are the same chemical, which are that go by different names, Wegovy and, also, ZepBound are probably the two leading products that are actually on the market treating obesity itself.

And, just to kinda illustrate, you know, these products work really well. There's no disputes that for type two diabetics or blood sugar control and regulation, these products work really well for those individuals and for weight loss. Some of the stories that we see in some of the instances of the clinical reporting for these products illustrates significant weight loss between thirteen and some instances twenty percent of the weight loss for the individual itself. So a large portion of, focus for, the population for a lot of clients that we service is actually focused on and their utilization in the population. So I kinda if we move to the next slide was going to illustrate.

Some of the trends that we're seeing for these drugs, because there's eight drugs we listed on the last slide there. They've actually a lot of them have indications that have kind of emerged. And this kind of, slide that we're looking at here showcases the GLP ones with diabetes and weight loss, and their new indications from twenty twenty five all the way through twenty twenty six.

And seeing the evolution of how these products that, again, originally started for type two diabetes treatment have evolved.

And you see that the predominant ones that are in focus here within twenty twenty five, most of these are actually indicated for weight loss. You see Zepbound and Wegovia are prime examples of that. You're seeing these new indications for heart failure, for, liver disease, treatments, and also obstructive sleep apnea. So they've really kind of gotten a lot of extra, ability to treat different individuals because of these new, labeled indications that have been approved by the FDA.

One thing I will go ahead and highlight too is this is to remember products like Zeppano and Wegovy. If you see that these individuals with heart failure and obstructive sleep apnea, the medication doesn't directly work on the disease itself. Right? It doesn't for sleep apnea patients make their sleep apnea go away.

It's the indirect mechanisms of losing weight around the throat or the midsection itself that helps the airways open up and that patient can breathe better. Same thing with heart disease. You know, if you take weight off the body, the circulatory system is not as under stress as it would be, and the heart actually is able to function more appropriately. So it's these indirect mechanisms for these weight loss medications that these manufacturers have got approval for.

So it's just something to go ahead and and hold in the back of your mind as, some of the something to think about with these products themselves.

The next slide of what I try to do here is not necessarily showcase things that have actually got, approvals just yet or actually close to approvals in the pipeline, which we just mentioned there. But this is one of the categories to this next slide I kinda showcase. Eli Lilly is one of the predominant manufacturers of these GLP one products, and they've got a new drug in the pipeline called redox tree tide. It's called triple g for short.

And this particular product, the reason I bring us is to illustrate some of the evolution of GLP one products and how fastly these medications are moving.

You can see on the right hand side here, I put a table together that illustrates the three predominant chemicals that are in this GLP one category. Semaglutide is the original product. It's goes by the trade name Wegovy and also Ozempic. You can see it's just one hormone GLP one glycogen like peptide one receptor product in its formulation.

Fast forward to the second evolution of this by Eli Lilly, which is tirzepatide, and that goes by the products, Manjaro and Zepbound. It's two mechanisms of action as GLP one and it's a GIP, a glucose dependent insotropic peptide product as well. So two hormones in that product give better birth trigger control and in some aspects, better weight loss as well. And then lastly is retatrutide. I bring this up is because it's actually the the one in the pipeline for the GLP one products that's gonna showcase three hormones and three mechanisms of actions that it's gonna focus on. And it's a GLP one product, a GIP, and also it has the glucagon receptor agonist type of product, ingredient as well. So this product, retrotide, is really working to focus on how insulin is secreted and sensitized in the tissues and also how glucose is released and absorbed in the body, plus the motility in your GI system for how food processes.

So in pharmacy, the rule of thumb is if you focus on three areas, three different areas for treatment of a disease, you usually have about eighty to ninety percent control over that disease. And that's why reditrutide is somewhat of a game changer. And the fact that it has these three three mechanisms of focus that's really gonna improve clinical outcomes. For blood sugar control, it looks amazing as far as the outcomes we've seen so far and the data has been released.

But, also, they're indicating that this has the potential to potentially be on par with bariatric surgery as well. So that's something that kinda showcase as well because bariatric surgery is not reversible, but retrotide is. And that's the thing to focus here too. As individuals stop these medications, remember all the the all the positive outcomes that they've had will actually revert back.

Right? So something to think about too why these medications usually have to be given on a long term basis to be successful.

The next slide I kinda put together here illustrates some of the employer coverages that we're seeing for GLP one medications, within, the US population as a whole. This is a great study that was showcased, by for employers through the truest, survey that was done. Diabetes on the left hand side there. You can kinda see a coverage for diabetics.

It's pretty much on par with what we would see and expect, to continue growth. Once a once a diabetic starts a medication, they usually will stay on that medication for the rest of their life, and that's kind of the normal trends you will see for that therapy. Right? Where weight loss on the right hand side illustrates some of the slower adoption that we're seeing by employers to actually provide coverage itself.

And what I can tell you from our book of business from Ellevance, it's about ten percent, ten, fifteen percent of individual clients have turned on coverage for weight loss products like the, Wagois and Zepbound agents. And you can see in the industry, it's roughly gravitated about twenty twenty eight percent somewhere in that category. But the thing on the right hand side is the light blue. You see that nineteen percent undecided.

There's some individual, clients and and, you know, providers that are still, undetermined, whether they're gonna do it or not. And, so something just to showcase. Not everybody has adopted, the weight loss, GLP one, like other clients, in the past here, the past of twenty twenty five. The reason that is I put this next slide to get together to kind of illustrate, some of the the rationale behind this and some of what we're focused on with a lot of clients that we talk with is there's an ICER study, which is the Institute for Clinical and Economic Review.

It's an independent committee that actually looks at, how weight loss medications have basically been impactful for members, and clients that have turned them on. Right? And, what they did is this study kinda was a a benchmarking for semaglutide, which would be the, Wegovy type of product, for example, and seeing how its current cost is seventy five hundred to ninety eight hundred dollars in cost, drives, the potential savings or medical offsets.

And that that threshold for acquisition cost is actually fairly high. Right? And, what we've seen for GLP one products is they typically are somewhere between twelve hundred to sixteen hundred dollars on average for most clients that pay for them. The take home message here is when the ISER study, panel study actually brought their study out, it it it showcased that wegovy, which is semaglutide.

It was, the members that would be on these for the rest of their life, for weight loss was a cost of about two hundred and seventy four thousand dollars in totality.

But the medical offsets, those individuals that would benefit for from the weight loss within, as far as, knees, hips, and any of the other products that you would see for, loose loss of weight on the body, the medical offset was only about sixty two thousand dollars. So the cost still for the products actually exceeds what the over medical offset or medical benefits are at this point. The clients in this aspect would be spending over two hundred thirteen thousand dollars in extra money and not getting a return on that dollar. So we anticipate that just like anything else, we need to see these weight loss medications get cheaper in order for those, you know, the the medical offset and the cost when they crossover or meet, and that's somewhere between three hundred and fifty to five hundred dollar category of cost, that's probably gonna be a sweet spot where all things align where it's gonna be best outcomes and best savings overall.

The next thing I wanted to kinda highlight too is, if we move to the next slide, was the growing trend for compounding for GLP one medications. A lot of this you saw on the nightly news by products like HEMs, Hers, and Rose. Those companies that are bringing their compounding agents to the market, because of the market shortage and the ability to compound when there's a shortage by the FDA's guidance. Just to kinda highlight this compounding is actually, as of May twenty second of twenty twenty five, the FDA has notified all these compounding pharmacies that they have to stop and cease production. So you're gonna see those nightly news commercials fall off, but also those members that are on these products are gonna have to gravitate back to the normal pharmacy benefits, that would allow coverage for the products that are, FDA licensed, which are Wegovy and Zipbound at this product at this point for these products.

So something just to highlight and for our traditional, all our traditionally, covered, clients for our benefit setup, we recommend that compounds be excluded. So our clients typically if a compound, the GLP one came in for coverage, it would be turned away or excluded because it's not it's not an FDA approved medication itself.

So something just to be aware of and how the market can change on a dime, right, in pharmacy for sure. Next slide I tried to illustrate here is just some of the best practices and strategies we've come across, and deploy with a lot of our clients. This is actually six fast. It's a focus that we work on, and to help individual clients.

One is formulary management, making sure that they have the appropriate, preferred products, on the formulary and that does appropriate clinical edits, you know, the the prior authorization step therapies and quantum limits are all in place to make sure they have adequate guardrails for individuals that are seeking GLP one medications, whether it be for diabetes or for, weight loss itself. Ensuring step therapies were appropriate where metformin still is considered the gold standard of care where type two diabetic should start, but those step therapies are deployed and actually, that members are following that step therapy before jumping to a GLP one.

Also looking at opportunities for, benefit designs to ensure members are using these pro pro products appropriately in a a periods of time as well. Some clients are asking they're seeking to go ahead and put, you know, limits of dollars of spent on weight loss medications, for example, to ensure that, you know, individuals use these products, get to the results that they need to, and then actually discontinue when when is, they're at that ideal BMI. And in some aspects, we're seeing that point of twelve to eighteen months of therapy before individuals meet their ideal BMI. So, again, different unique benefit designs that are opportunities for clients, that we go ahead and we've discussed and have available to go ahead and deploy if need be.

We also look at adherence measures to make sure diabetics are taking the medications correctly in case you wanna be adherent in order to be the dose impact of benefit for being on these medications themselves. A lot of the other things that we look at too is real world evidence for a lot of the clinical criteria that we've designed and build to go ahead and manage GLP one medications. You look at the study data for populations that have been on these medications and real world impacts for those results as well because GLP ones from a therapeutic standpoint are still very young as far as medications go and pharmacy that is.

And so this new data, this new evidence and the amount of individuals that are now on therapy gives great insights on opportunities to best manage through clinical criteria that what we're seeing in the real world evidence for members that are on these drugs themselves. So something to think about. The last thing I'll say about these two is all the individual, GLP one manufacturers, whether it, for weight loss, if you looked at their, studies that they did before they launched their medications to the actual, public itself, is that all the individuals that are using these products, whether they be receiving medication or be in the placebo group with no medication, they're all enrolled in a weight management program.

And that weight management program, even for this placebo group, kind of generate about three to four percent of, weight loss in those individuals as well, compared to not being in the program. So something to think about and that's one of the things we communicate to our clients is that weight management program is a hand in glove approach when you have GLP ones for weight loss turned on. Super important, for that, to be, deployed.

Alright. And with that, I will stop for a moment here, and I will transition over to Christine to go ahead and walk us through the weight management, program.

Wonderful. Thanks, Matt.

So, yeah, those were in addition to all of the GLP one management strategies that Matt just reviewed, I do want to echo the, how we are hearing more right now in the industry about how complementary lifestyle management programs, which include diet and activity modifications, are necessary to support weight loss and help sustain those results.

So with all of these market dynamics, plan, sponsor, and member needs in mind, we designed a weight management program in partnership with LARP that supports members throughout their weight loss journey.

The program's comprehensive approach, it addresses physical activity, nutrition, social determinants of health, along with medication support for those who qualify to help achieve long term success. It's also designed for all plan sponsors with or without weight loss drug coverage.

A couple of highlights to call out with the program. It's a scalable digital platform with access to live coaching, webinars, and peer support communities for all members who are participating in the program.

It's embedded in the benefit coverage workflow, so that includes physician communications and attestations, PA communications, denials and appeals communications, and processes.

The integrated program also enables for a seamless eligibility file transfer, vendor management, billing, and reporting oversight. And what the program billing, and reporting oversight.

And with the program integrated as part of the members' health benefits, it allows for an easy program startup through the Anthem Sydney app.

So if we go ahead to the next slide, just a very brief overview of the program. It offers three layers of support. There's healthy weight, GLP-one companion, and weight maintenance.

It focuses on an individual's overall health, taking into consideration, as I mentioned, behavioral health and social drivers of health, while also ensuring a balanced diet and consistent exercise habits.

So for members prescribed weight loss medication, the program offers a GLP-one companion module for medication management, and that includes support around side effect management and injection anxiety.

The weight maintenance module also is there to support those who have achieved their weight loss goals, whether it's with medication or without, and ensures they are set up for long term success.

It's also set up to the integrated approach also coordinates with our care coordination team through advocacy programs.

And the member engagement in the program is visible from the nurse case manager perspective and can also identify additional opportunities there.

So With that overview, I'm not going to take up too much more time here because I know that, Mike is waiting to dive into the demo so you can see the program in action. I'll go ahead and turn it over to Mike.

Great. Thank you.

Well, we'll dive into the actual program here. And, as Christine was mentioning, this is really a holistic weight management program that is offered here in partnership with Carillon, through Ellevance. And, really, it's three modules. It's healthy weight, which is really the foundational program that is set up today, in addition to a GLP one companion component for folks who may be taking the medication or likely being prescribed it.

And then there's also, weight maintenance. And so I'll talk to you about that but the key components within kind of that healthy weight or the foundation within these programs is not just talking to the individual and personalizing their weight loss journey, it's also reminding them of key factors that can impact that weight loss journey. It's also, you know, getting active, eating healthy, if they're using tobacco products, how tobacco cessation might be something to assist or help with. It's weight loss, it's stress and anxiety, it's medication adherence, as Matt was mentioning, making sure that they're on top of their medications, social determinants of health depending on their situation, they may need some additional help.

We also know that sleep patterns can affect folks, as they try to lose weight. And And then in addition to that, we do screeners along the way throughout our program to ensure that we're doing a PHQ two screener along the way just to double check to see where the person is at from a behavioral health standpoint and how they're doing. Upon registration in the program, members are given a connected scale, which is available for them, and that's where we start to track, you know, their weight loss and their weight loss journey and a lot of their data points. In addition to that, if they have connected devices like Apple HealthKit, Google Fit, or Fitbit, we can assist the individual with getting those set up connected through the app so that we can track their activity and see how they're performing.

In addition to those components, we also have three other components that I talk about, which is the three c's of coaches, community, and customer support. It's very important to understand with the LARC program and using an AI first coach, which we've done a lot of research and realized that the majority of questions, seventy five to eighty five seventy five to eighty percent of questions in the weight loss space can be answered through our AI coach. But we also know that that human intervention is needed at times. And so having coaches available is one key component of part of our three C's.

And with that, we have, you know, oversight by our medical director all the way up to our CMO to ensure that those coaches are available. Within the program, members are given ten live coaching sessions per year. What's really great with the program is through those interactions with members. If we feel a member is struggling based on the interaction with their AI coach and kind of their questions coming in, we actually will proactively send out a prompt to the individual to see if they'd be open to having a live coaching session.

We don't just leave the member wondering or kind of next steps, we want to help proactively help them to get out of that situation they're in where maybe they're struggling and support them. In addition to that, community is a big piece with the weight loss journey and we know that having interactive webinars available to members where they have the coaches leading a session on different topics, could be portion size control, it could be holidays are coming up and what are some tips around the holidays of what you can be doing.

Peer support groups are also another thing, you know community by having a peer support group is really big and so we support individuals by offering private Facebook groups where they can join and have a peer group that they can meet with, talk about what's working well, what's not working well, figure out some tips together.

That peer support is always a big piece. And then in addition to that, we have customer support always available seven days a week to support using the app. If there's questions or anything that come up that they may have, support needs on, we're available through customer support to assist them.

And then the other key piece that I like to highlight before I dive into the demo, so you can kinda see what that member experience looks like is just the enrollment process. And so upon getting eligibility, once a client goes live with Carillon, we'll receive an actual eligibility file, and then that is the moment when we will actually do our marketing campaigns from a LARC standpoint directly to the member at the member level. That's where we'll reach out to the member, and we'll let them know that the program is now available to them. Prior to that, as an employer, there's always the option of utilizing the robust toolkit that Carolina has put together for clients to do pre kind of go live date and marketing, to their community and let them know that the program is going live on next date.

But from our standpoint, when we get the actual enrollment and we're targeting the members and working with them, we send them a flyer, it has our URL on it, or it also has a QR code on it, which is really easy. Folks can then just scan their phone, it automatically prompts the app, and they can download the app right there. It's preceded by then answering a couple simple enrollment questions, like their date of birth, their name, etcetera. And then we'll do a member match on the back end with the eligibility file.

It all happens behind the scenes within seconds and minutes, to ensure the member is eligible for the program. And then from there, within minutes, the person is then moved into the ability to start engaging using the app and being set up. All of this takes place on average three to five minutes for an individual to get set up and going with the program. So very easy, very simplistic.

We try to keep it simple for them.

So let me dive into the actual three modules of our program.

So as part of the weight management program, the first module is Healthy Weight. And so what I'm gonna do is play for you just the actual app experience on the right hand side of the page. It moves a little quick, but I wanna give you the experience of what it kinda looks like. And I'll talk about the program as that's rolling through the screen here.

As part of the program in Healthy Weight, the initial thing that we like to do with the individual upon their registration and getting set up is, you know, let's work with them to set up their goal weight. So we'll ask a series of questions, again, just to get them set up in the program. And so we're gonna ask them what's their current weight, their current height, their sex, and then also are they pregnant or are they doing any cancer treatments? Because we know the latter two items are ones where weight loss is not prescribed.

And so we want to make sure that we're appropriately offering the program to the right people where they're at, and supporting them. From there, what we're going to introduce to them is how does the actual app work. We'll talk to them about how they can log their weight. We'll share with them the data tab features like the weight chart, which you're seeing on the screen there as an example, and then we'll dive into talking to them about how the app will engage with them, how it will work with them.

We do this through a series of missions, but before even that, we talk to them about how our communication in the app is very easy. And the one reason it's super easy is we use a traffic light type of philosophy.

The reason for that is we all know since we were little red means stop, yellow is caution, and green is go. So if you're getting greens on your responses and things, that means everything's working great. Yellow, obviously cautionary, we might need to pause, make some recommendations, or red is, hey, that's not working for you, let's figure out an alternative for you to support you. The other thing is all these missions.

The key part of our program which differentiates it from a lot of other programs out there is we do a series of seven missions right up front to make sure that the person is mindfully ready for their weight loss journey. We know many people, we have all had it, I've had it myself, where January comes, the new year starts, and we say we're going to lose some weight. Three weeks into it, we stop and we're kind of off track. So as part of this program, we want to make sure you do these missions or education sessions to ensure that the person is mindfully motivated and prepared from a kind of mental standpoint of saying, hey, I'm ready for this.

I know what I need to put in. I know how this is going to work, etcetera.

In addition to that, we want to make sure that we're setting them up with that activity coaching. So we'll talk to them about those connected devices that I shared earlier. We'll make sure that we get that connected for them. We'll support them on that.

We'll alert them to the resource library that's available to them. We'll talk about tracking sleep patterns like you see on the page. Right now, it's scrolling through that of how important their sleep is. We'll talk about that for them as well as just reminding them that through this module you still have access to live coaching sessions, and you may get prompt with that.

In addition to that with the program, what's really neat is we do what's called daily chirps where we just do a quick check-in to see how the person is doing each day and we do a lot of pre prompted responses so the member doesn't have to take a lot of time to respond back. They can just hit the pre prompted response, letting us know that they're good and here's where they're at and how it's working.

In addition to healthy weight let me move forward here.

The next piece of, the program, which I find very much a differentiator in our offering, is our Sustainable Nutritional Coaching app. And so this is all part of within that app the member is using, and it's across all three modules.

I'll play this here to show you kind of an experience of what that looks like. But this is all created under the large language model based AI AI from our medical director all the way up to our CMO as well as all those trusted sources you see on the right hand side of the page.

Reason we do that is because we know that we wanna make sure we're providing accurate information to individuals who are asking us questions around their weight loss journey. We don't want to direct them somewhere where it's, you know, a universe of open Google and people are just getting whatever. We want to make sure we're giving them educational appropriate answers to what they're looking for.

Within this app, what's really neat is we make personalized recommendations for the individual. So as part of our program, when I say personalized, this program is not based off one certain type of diet. We know that within our US population we are a very diverse country and so we want to make it personalized and from a health equity standpoint meet everybody's needs.

So for example, you can get personalized recommendations to your favorite restaurants and also you can also get, recommendations at home if you have certain items in your refrigerator, in your pantry, and you're saying, hey. What can I make for dinner?

The app will actually make recommendations for you and support you on maybe it's those alternative choices or things that you could make. In addition, if you're a member, who eats a, you know, your favorite food is, say, Indian food, you can type in your favorite Indian dish and then actually the app will make recommendations for you as to what are some good options, what are some things to avoid, things like that. So again, it's very personalized, for that individual as well as culturally available to support the individual where they're at. In addition to that, it will walk them through how they log their food, how they can get different suggestions, recipes, things like that that are found out there within our resource library. And then, obviously, we just wanna support the individual holistically to ensure that we're meeting them on a personalized level to support their their needs on their weight loss journey.

Next are for those individuals who would move into module two that is the GLP one companion program. This is really important for those individuals who are currently taking a GLP-one potentially for weight loss or even if you're a member who is diabetic and you're taking a GLP-one medication today. We want to make sure that we're supporting members who are taking those medications.

As folks previous to me on the call today mentioned, you know, there are certain side effects that can happen with GLP one. And with that, you know, one of the concerns is certainly site injection concerns, issues there. What does it mean? What should I do? And so as part of this program, we wanna make sure that we're alerting the member with resources to support them through the missions about, hey, here's what the the daily check-in is gonna look like to check-in on you to make sure that everything's going okay. Are your shots going okay? Are you having any side effects?

What can we do to support that? So a lot of our missions or educations are around some of that side effect support for the individual. So case in point, you know, we know that many folks who take a GLP one may have GI or, nausea type issues. And so with that, we wanna make sure that we're gonna support that individual.

So we do a series of questions to find out if it's less severe, more moderate, or if it's more extreme or concerning in regards to their symptoms and where they're at. And the goal of that is really to help the individual in that moment in their personalized space to say, Hey, what can we do to help them? And so if the person comes back with less severe or just general symptoms, we're able to make recommendations for them to say, Hey, let's incorporate more water. Let's incorporate more bland foods.

Things that would help in that situation.

In that way then the member is not thinking, oh, I need to run to the ER, I need to run to the urgent care, etcetera. We can address it right there in the moment and hopefully avoid those other costs from happening. Now if it is more severe, one of the key pieces and nice parts of the app is that we do provider escalation.

Upon registration we'll ask members if they're willing to share their provider information, their phone number, etc. And if so, and we know that based off the answers the member is giving us in regards to their symptoms and concerns they're having, we may recommend provider escalation. And so, we'll prompt to the member that, hey based on your responses to us today, we'll wanna make sure that you get some additional support. Here's your provider information you provided, and we'd recommend that you make a phone call to your provider to discuss those symptoms.

We wanna make sure that it's making it easy for them so they don't have to go look for the phone number. It's right there. They just click on that prompt, and it'll pull up the information they shared. So they'll have the phone number handy and available to make that phone call, when needed.

In addition to that, we also wanna make sure we do some missions and education around the GLP one and the fact that you don't just lose fat, you also lose muscle mass. And so we wanna make sure that we alert the members to say, hey. You know, as part of your weight loss journey, let's make sure that we're keeping up your activity and strength training. You know, here are some simple things that we can do to support that, track that, make sure that you're, doing what you need to do to keep up that muscle mass strength while losing weight.

The other key piece in this component that's really key is knowing that they're taking a medication. They can actually set a medication reminder, and they can get that, so that daily they get, you know, or weekly or depending on when they need to take their medication, they'll get that reminder prompt sent to them, letting them know that, hey, remember you get to take your medication on this time, this date. There's an example of it on the screen there for folks to see.

And then ultimately, as part of the GLP-one companion program, as they start to proceed and they start losing their weight and they start getting close to their goal weight, what we'll want to do is also talk to them about the fact of what does that transition look like. So as they eventually, hopefully, have built in these lifestyle changes, they have the weight loss, they know kind of what they're doing, what can we do to help them as they transition to our weight maintenance program? And so as one of our last missions, we'll talk a little bit with them about what that transition looks like and then moving them over into our weight maintenance program. So a lot of key education and support that's tailored through a series of missions to ensure that the member is on track where they need to be in getting that additional support from a lifestyle and behavioral change standpoint moving forward to sustain the overall weight loss goal.

Next, we'll get into weight maintenance.

And so weight maintenance is really another key differentiator that was really highly talked about as we built out this program together, with the Carillon and Elevance team is we wanted to make sure that in addition to members getting that lifestyle and behavioral change support from a holistic long term standpoint and also being very personalized to each member, we also wanted to make sure that we had a maintenance component built in at the end of it so that members know what happens. So we know people if they go off the medications, and Matt mentioned this earlier, if they go off their medication, they're likely to gain a little weight back.

And so what we want to do is remind those folks who've been very successful with the lifestyle and behavioral change components, who've had success, that, hey, if you go off the GLP-one, you may add a few pounds back, but remember these are all the other things you did to help you to lose the weight. So this was where your activity was at, this is what the meals that were you were eating that were working well for you. All of those pieces that they can find within their data tab, which carry with them as long as they have the app. So it never goes away.

They always have that ongoing support, where they can continue to look back to say, what worked well for me to be successful with my weight loss and maintaining it long term? And so we do a lot of education and missions around making sure that they're aware of all those great things they did to this point to be successful long term to support them. In addition to that, they still have access to the community support pieces of the interactive webinars, the peer support groups, the live coaching, that they can still connect with if they need to. So there's all these other components that are still here even in this phase to ensure that we are ultimately seeking that end goal of long term sustainable weight loss.

So that's really where the key pieces here is really making sure that we're supporting those members long term, having that success, and not just saying, hey. You hit your goal. Wait. Congrats.

No. We don't wanna do that. We wanna make sure that they know that they always have right at their, you know, on their app or their phone, the support of, the program right there to support them long term. So a lot of great features there.

Hopefully, these, demos today was very supportive and could show you just kind of a little bit of that experience of what the member goes through.

I'll show you one other quick slide here.

Just let me move forward.

So this is really out of that data tab that's at the bottom of the app. I love to show this slide because of the fact that it shows kind of all the different things that we're measuring for that individual.

And so this is really that weight, that activity, their food, their sleep. We also, you know, members can put plug in notes of what what worked well, what didn't work well, all that. And it's all very simplistic. We truly try to make the app very user friendly. And again, from a overall program standpoint and a holistic approach, what we try to do too is to ensure that some of these data pieces can get flown back into that advocacy piece that Christine was talking about, so that we're also helping the individual if there's maybe other comorbid conditions that maybe they're working with a nurse team on, over at Carillon or with an Anthem or wherever they're at and that we can support them. So it's really holistically trying to find the best, approach and what we can do to support these individuals.

And I think that is it.

So I'll turn it back to, Lasania.

Awesome. Thank you so much, team. What a wonderful presentation. A lot of information.

And, just so everyone know, you will receive a copy of this presentation as well as the recording afterwards. And so at this time, we are we are gonna open up the floor for questions. If anyone have any questions, feel free to enter them either in the chat box or the q and a box.

And, while they're doing that, we do have a couple of questions that have come. Again, I wanna thank everyone for joining us, the wonderful presentation, a lot of information, a lot of great information. So, again, everyone will receive a copy. But the first question we have is, this happened while Matt while you were presenting, the question came in and they wanted to know is the zepatide a compound?

And I hope I pronounced that right.

But it's the t r z e p atide a compound.

Is that for Matt to answer as a pharmacist?

Or if anyone else knows, but it it did that question did appear when Matt was presenting.

Lisnea, this is Denise. I can take that question.

That is a brand medication, but there are compounding pharmacies that may just like they did with the Ozempic Wegovy generic ingredient called, semaglutide.

And that's what Matt was referring to where he was saying that they advise clients not to cover compounds because the FDA has issued some warnings saying that, you know, now that there's not a significant shortage of the original brand medications, they really they don't like the idea of these medications being compounded in significant volumes.

The reason that that we've brought that up is because there are a lot of physician owned clinics and organizations like the HIMS, HERS that are promoting the generic compounded version of the medications.

Okay. Thank you, Janice.

Sure.

And like I say, if anyone else have any questions, feel free to, throw it in the chat box or the q and a box. And I do have another question that's inquiring whether or not there's a PDC for this session.

So I'm not sure if they're referring to any credits that's gonna be provided. I know we will provide the SHRM credits and the HRCI credits, so I'm not sure if they're inquiring about that or not. But I will get back with them regarding the PDC, for this session. And then we did get another question. Oh, they're coming in now. I am on the rezepletide and get it from a nurse practitioner from an online pharmacy. Will I still be able to get it?

I can field that as well. It's very likely that you'll still be able to obtain the medication. A lot of the online pharmacies are still able to source the compounded products, but it is something that you'll wanna kinda keep tabs on because each organization is gonna be a little bit different. And again, just be aware that the FDA really is giving some guidance against significant use of the compounded versions.

There will be an authorized generic semaglutide later this year, and so that's gonna be a nice opportunity for people to get the official generic at a cost reduction.

If you think about the average for these medications being maybe fifteen hundred to eighteen hundred dollars a month, we believe the generic will be somewhere around six to eight hundred dollars a month. I know a lot of the compounded products are a lot lower. I've heard a hundred and twenty dollars a month.

So we can understand where consumers are looking to, you know, really get the most cost effective product. But just be aware that there is some scrutiny around these compounded products.

And the reason so somebody also asked, is there a reason that the FDA is poking around? It really is because they they initially allowed some leniency for compounding pharmacies because there was a shortage of the medications for diabetic patients.

And that happened because people were starting to use them for weight loss. And so there there just wasn't enough of the medication being produced.

Manufacturers got behind that and started producing more of the original brand products. So there really isn't a shortage situation any longer and the compounding pharmacies, are not as highly scrutinized by the FDA.

They are, you know, they're certainly governed by the same standard of care and clinical efficacy but the original brand companies still hold patents on these original brand drugs. And so if there's a significant number of compounding medications being produced, that really does interfere with the patent rights of the original brand company.

Awesome. You may have already answered this but, the other question was what's wrong with saving money if a compounding pharmacy can save money?

Yeah. And it really is around the original company doing the research and development, putting the the investment, the financial investment in the brand drug.

And they have a legal patent to protect that drug for anywhere from ten to fifteen years typically after they launch the medication.

And so it's a, it's a legal issue if someone makes the generic version without the approval of the FDA. And again, this was really supposed to be more for a short term, but a lot of people caught on to the fact that these were lower cost alternatives.

And I I think, you know, Matt spoke to this and then certainly Mike and Christine with with more of the the individual support that really has to align to these medications. What we what we really wanna help people see is that there needs to be some coaching and some behavior modifications, some exercise and nutrition goals that go along with the medications.

Otherwise, you know, folks could run the risk of losing bone density, losing muscle mass.

And we've, you know, we've heard some some situations where that has occurred if if folks aren't getting the right kind of other support they need. And so if you're, you know, if you're going through an online pharmacy or a compounding pharmacy, the goal and the hope is that you have a nurse practitioner or somebody that's helping you through this or that you are part of some type of a behavioral support program that encourages some of the changes that are gonna sustain the weight loss over time. And, you know, some some practitioners believe that this is that obesity should be looked upon as a chronic condition and these medications should be used on a chronic, you know, therapy condition.

But others are focusing on folks getting to goal, changing some things in their life, nutrition, exercise, and then weaning off the medications slowly over time. And so that takes a bit of a more strategic approach as well. So just, you know, we just wanna make sure that everybody understands that these medications, you know, are safe and effective, but they also come with the risk of side effects occurring. And if not, if weight loss isn't done properly, there can be unfortunate side effects with muscle and bone density.

Well said. Thank you again. So again, a special thanks to our panel of presenters for this wonderful information.

Like I said, we will make sure we provide a copy of the presentation slides as well as the recording. And for those of you who did stay on the entire time, you will receive your SHRM and HRCI credits. And so on behalf of McGriff, thank you again for your participation, and please stay tuned for future webinars hosted by our groups. Thank you, and you have a wonderful rest of your day.