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GIC report: GLP‑1 weight‑loss drugs a major driver of rising plan costs; PBM switch and procurement changes produced mixed savings
Summary
A retooled GIC out‑of‑pocket report found member out‑of‑pocket costs largely stable while GIC‑paid spending rose across many categories; GLP‑1 weight‑loss drugs accounted for a substantial share of recent drug‑cost increases, while procurement and a PBM change to CVS reduced costs in some generic and specialty categories.
At its May 12 meeting the Group Insurance Commission (GIC) reviewed a reworked out‑of‑pocket report showing relatively stable member out‑of‑pocket costs but rising GIC‑paid spending driven in part by increased utilization and unit prices across multiple medical service categories and a sharp rise in GLP‑1 prescriptions for weight loss.
Lauren Makashima, the GIC's data analytics manager, said the report adds GIC‑paid trends alongside member out‑of‑pocket metrics to clarify the drivers of premiums and affordability. She reported that non‑Medicare members spent about $59.65 per member per month out of pocket in fiscal 2024 and that Medicare members averaged about $51.51 PMPM. At the same time, GIC‑paid medical and drug PMPM increased…
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