Rethinking GLP 1 Coverage Through Transparent, Consumer First Pharmacy Models

Summary

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Podcast Summary

Becker’s Healthcare Podcast

Episode: Rethinking GLP 1 Coverage Through Transparent, Consumer First Pharmacy Models
Date: January 24, 2026
Host: Elizabeth Caslo (Becker’s Healthcare)
Guest: Bethany Stein, Segment President, Pharmacy at Humana

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Episode Overview

This episode explores Humana's evolving pharmacy model in response to employer demand for responsible GLP-1 (obesity management drug) coverage. Bethany Stein discusses their partnerships with manufacturers like Eli Lilly and Novo Nordisk, providing insight into transparent, consumer-centric pharmacy models that aim to balance access, affordability, and adherence for weight loss medications.

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Key Discussion Points & Insights

1. State of GLP-1 Coverage Among Employers

• Employers are shifting from questioning “if” they should cover GLP-1 drugs to determining “how” to cover them responsibly ([02:05]).
• Priorities: Predictability, control, and transparency—without restricting access for those in need.
• Employers now favor benefit designs that stratify populations based on clinical need (e.g., high-risk metabolic, “weight-only,” and phase-based use), rather than treating GLP-1s as a monolithic cost ([02:38]).

2. Rising Costs and the Need for Strategic Segmentation

• GLP-1 spend has risen rapidly: up 35% in 2024 and 25% more in 2025 (Gallagher study cited) ([03:33]).
• Employers require clearer models to balance cost with value.

  “So that kind of segmentation helps employers move from this broad utilization concern to an intentional strategy where they can support the right patients without runaway spends.” – Bethany Stein ([03:11])

3. Partnership Model with Eli Lilly and Novo Nordisk

• Humana collaborates with manufacturers for direct-to-patient GLP-1 access, aiming for better cost and access outcomes ([04:44], [05:18]).
• Centerwell Pharmacy serves as an extension of Humana’s consumer-first mission: no hidden fees, transparent pricing, focus on clinical outcomes.
• Metrics: 15% fewer ER visits and 13% lower hospitalizations among Centerwell patients compared to other pharmacies ([06:22]).

  “We deliver that true transparency, right? So for 30 years we've operated with no hidden fees, no games and complete visibility for the health plan.” – Bethany Stein ([06:46])

• Most generics cost <$2/month; proactive support for affordable alternatives ([07:04]).

4. Bending the Cost Curve While Protecting Access

• The partnership model is designed to simplify access, reduce out-of-pocket costs, and maintain predictable spend ([07:38]).
• Centerwell’s approach: expand access while safeguarding quality and affordability for payers, employers, and consumers ([07:55]).

  “We're not restricting access, we're expanding safe, affordable, high quality access while building a cost structure that is sustainable for payers, employers and consumers over the long term.” – Bethany Stein ([08:03])

5. Medication Adherence as a Key Success Factor

• Adherence improves outcomes and reduces costs. Centerwell’s adherence rates surpass those of other pharmacies by 260 basis points ([08:37]).
• Interventions: reminder calls, pharmacist-led barrier assessments, population segmentation by adherence risk ([09:12]).

  “When members take their drugs, we just see the better, better medical outcomes that that result.” – Bethany Stein ([09:48])

6. Why Now? The Rationale for Deeper Industry Collaboration

• Increased attention from regulators and payers on affordability and safe access ([10:23]).
• Drug shortages and non-FDA alternatives created patient safety risks.
• Market dynamics (cost/control) have created opportunities for alternative benefit models anchored by strong payer-manufacturer partnerships ([11:01]).

  “The environment, I would say today makes partnerships like ours especially valuable because they deliver on what the market is demanding right now.” – Bethany Stein ([10:33])

7. Advice to Other Industry Leaders and Payers

• Rethink the ecosystem for access, affordability, and experience ([11:55]).
• Design with the consumer first; prioritize transparency and predictable cost.
• Lean into partnerships; no single entity can solve these challenges alone.
• Embrace data, transparency, and flexibility in benefit designs ([12:33]).

  “The GLP-1 moment isn’t just about GLP-1s. It’s about rethinking the entire ecosystem around access, affordability and consumer experience.” – Bethany Stein ([11:56])

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Notable Quotes & Memorable Moments

• On strategic segmentation:
  “Employers are increasingly asking for benefit designs that stratify populations thoughtfully rather than treating GLP1s as one large undefined cost category.” – Bethany Stein ([02:37])

• On transparent, consumer-driven pharmacy:
  “We want to make pharmacy more transparent, more consumer friendly, and more clinically effective at scale.” – Bethany Stein ([00:26])

• On the pharmacy’s impact:
  “Center well, patients have 15% fewer ER visits and 13% lower hospitalizations than patients using any other pharmacy in our network.” – Bethany Stein ([06:22])

• On cost-containment and value:
  “When you build models that prioritize transparency, clinical quality and predictable cost, you don’t just improve access, you naturally bend the cost curve because the system becomes simpler.” – Bethany Stein ([12:01])

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Timestamps for Key Segments

• 00:59 – Bethany Stein’s background & Humana role
• 02:05 – Employer GLP-1 coverage demands & design trends
• 03:33 – Rising GLP-1 costs and need for segmentation
• 04:44 – Partnerships with manufacturers, direct patient access
• 06:22 – Centerwell’s outcomes & transparency model
• 07:38 – Expanding, not restricting, access to GLP-1s
• 08:37 – Medication adherence strategies at Centerwell
• 10:23 – Why now is the time for deep manufacturer-payer partnerships
• 11:55 – Advice for industry: transparency, collaboration, data sharing

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Concluding Takeaways

• The surge in GLP-1 demand and costs is driving a rapid reevaluation of pharmacy benefit models.
• Transparent, consumer-focused approaches—like Humana’s Centerwell—can bend the cost curve without sacrificing access.
• Strong, direct partnerships with pharma manufacturers are seen as essential to sustainable, scalable benefit models.
• Medication adherence programs are central to achieving clinical and economic outcomes.
• The episode calls on healthcare leaders to design for the consumer, embrace partnership, and foster full transparency for a sustainable pharmacy ecosystem.

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Transcript

[A]

This is where health insurance leadership comes together. Becker's 4th Annual Spring Payer Issues Roundtable brings together over 400 payer and health plan executives and more than 100 speakers to Chicago, April 13th and 14th. This year's event includes keynote conversations with the industry's top leaders and former President George W. Bush. For the full agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you here in Chicago.

[B]

Hello, everyone, this is Elizabeth Caslo with the Becker's Payer Issues podcast. I'm thrilled today to be joined by Bethany Stein, segment president of Pharmacy at Humana. Bethany, thanks so much for chatting with us today.

[C]

Yeah, happy to be here. Thanks for having us, Liz.

[B]

Yeah. So before we jump into the conversation, can you tell us a little bit more about yourself, your healthcare career background, and what your role is at Humana?

[C]

Yeah, happy to do that. Bethany Stein, As Liz said, president of Humana's Pharmacy segment centerwell Pharmacy. I am a pharmacist by trade and started at Humana right out of pharmacy school as a resident. So today I oversee the strategic growth, operations and P and L of Humana's three different pharmacy businesses, which include centerwell Pharmacy, our home delivery pharmacy, centerwell Specialty Pharmacy, and then Humana Pharmacy Solutions. And I would just add that my team's focus is incredibly simple. Right? We wanna make pharmacy more transparent, more consumer friendly, and more clinically effective at scale.

[B]

That's great to hear, Bethany, and thanks again for joining us. So the big news I wanna talk about today is how Humana centerwall Pharmacy is going to dispense Eli Lilly obesity management drugs through its employer plan sponsored carve out programs. What are employers asking for right now when it comes to GLP1 coverage? And how does this partnership enable Humana to respond to that demand?

[C]

Yeah, thanks, Liz. I love this question. I think employers are in a very different place with GLP1 coverage today than even a year ago. The conversation has essentially shifted from should we cover them? To how we cover them responsibly. They're looking for predictability, control and transparency, but without restricting access for the people who truly need these medications. So what we're hearing consistently from employers is that not all GLP1 use is the same. Right? So different employee populations have very different clinical needs, whether that's dose escalation, duration of therapy, or just like the type of behavioral support required to be successful. So employers are increasingly asking for benefit designs that stratify populations thoughtfully rather than treating GLP1s as one large undefined cost category. So, for example, some programs that distinguish between high risk metabolic patients that may see the greatest downstream medical savings, a weight only population where employers may want more guardrails and accountability. And then finally, maintenance versus initiation phases where intensity and cost can differ significantly. So that kind of segmentation helps employers move from this broad utilization concern to an intentional strategy where they can support the right patients without runaway spends. And honestly, Liz, the cost pressures are real. Right? A recent Gallagher study showed that GLP one drug class spend increased 35% in 2024 and another 25% 2025. So even with good clinical outcomes, that cost trajectory is truly outpacing the near term medical savings. So employers are rethinking their models and leaning into approaches that give them clearer line of sight to both utilization and value. And so again, going back to integrating segmentation, clinical oversight and a more transparent pharmacy model, we at Centerwell are really helping employers structure GLP1 benefits in a way that meets the moment, sustainable, intentional and still high quality for their members. So ultimately, it's about giving employers the confidence that they can offer these important therapies without sacrificing affordability and giving employees a support model that actually helps them succeed. So I would just say that is in general why we are so excited with where we're going in our partnership with Lilly and other various partners within this ecosystem.

[B]

Yeah, so I was actually going to ask about those other partners just to give context to our listeners. Humana is also working with Novo Nordisk on direct to patient WeGovy access. And there's also just beyond that, some recent research points to slowed medical cost growth for GLP1 users in the long term. So how do those collaborations with manufacturers, so Eli Lilly, like what we're talking about today, Novo Nordisk, work together to bend that cost curve without restricting access. Just elaborating a little bit more on those stratification points that you mentioned earlier.

[C]

Yeah, I would just say I think GLP1s are both clinically transformational and financially challenging at scale. Right. And so that's exactly why we're talking about such a deliberate approach. So Humana is building a consumer focused health care company and pharmacy is a strong expression of just that strategy. Whereas centerwell Pharmacy, just as background information for you all, is, was built originally for the health plan, by the health plan. So from day one, it has been designed around outcomes, transparency and affordability, not spread pricing, rebate fees or intermediaries. And so we have results that really speak for themselves in the form of better outcomes, right? Center well, patients have 15% fewer ER visits and 13% lower hospitalizations than patients using any other pharmacy in our network. And we validate that annually. We see better experience, right? Our net promoter score is consistently 15 points higher than other pharmacies. We, we deliver that true transparency, right? So for 30 years we've operated with no hidden fees, no games and complete visibility for the health plan. And then lastly, affordability is just built into our model, right? At the highest level, 90% of our generics cost less than $2 a month, many with no copay at all. And we truly proactively help members find lower cost alternatives and financial assistance for high cost brands and specialty drugs. So when you combine all of that with home delivery scale and a consumer first mindset, you really end up with a pharmacy model that is uniquely aligned with to what the GLP1 marketplace requires. Predictable pricing and clinical integrity. And so that's why we're expanding this model beyond Humana members to a direct to patient pharmacy solution model for GLP1s. And so to get to your question, our collaborations with manufacturers like Novo Nordisk and Eli Lilly are built upon those same principles. We just simplified access at a lower out of pocket cost. And so this truly does bend the cost curve and expand access. And we're doing it exactly how a consumer health care company should do it, right? Simplifying the ecosystem, removing friction and waste, delivering predictable, transparent pricing, improving outcomes and adherence, and scaling safely and responsibly. So we're not restricting access, we're expanding safe, affordable, high quality access while building a cost structure that is sustainable for payers, employers and consumers over the long term. And I believe that this is really the future of pharmacy care, right? A consumer centric, clinically guided, transparent, and it's built to support the next generation of therapies at scale.

[B]

So I actually wanted to ask a little bit about that adherence point, because that is such a concern here. What steps is Humana taking while they're working with employers on promoting adherence? And what else do you have to say on adherence? Because that is just such a big concern in terms of the cost here.

[C]

Yeah, I totally agree. And if you taking a step back, I would say the strongest support around medication adherence is a lot of the clinical programs and support elements that we have in place today. So just another metric for you. At Centerwell Pharmacy, we see about 260 basis points better medication adherence than we see in other pharmacies in our network. And so our Pharmacy is truly incentivized to, to focus on adherence because we know there is a ton of downstream clinical impacts related to that. The hospitalizations I mentioned, the ER visits, those are all lowered. And this is well studied in the industry when patients take their medicines. Right. And so I would say at Centerwell Pharmacy, we have robust medication adherence programs that are in all forms, whether it be reminder calls or having conversations with pharmacists around barriers to adherence. We segment the population on those that are high risk of falling out of medication adherence versus ones who we know may just need a little bit of a nudge or a lower cost intervention.

[B]

So.

[C]

So we've done a ton of research on this. I would say we have a ton of clinical interventions and I'm really proud of the investments that we have made to support medication adherence because it is a win, win solution. When members take their drugs, we just see the better, better medical outcomes that that result.

[B]

Yeah, absolutely. And you mentioned this earlier, but you think that employees are shifting their perspectives on GLP1s at least in the past year. Could you talk a bit more about why now is the time to deepen relationships with manufacturers offering weight loss drugs?

[C]

Yeah, it's a great question. The healthcare system is under pressure to lower drug costs and expand access.

[B]

Right.

[C]

Creating a truly a favorable environment for an alternative benefit model. The system does need a new model and both manufacturers and employers know that they cannot solve this alone. So the environment, I would say today makes partnerships like ours especially valuable because they deliver on what the market is demanding right now. But just going back, I mean, GLP1s were definitely the catalyst, and here's why. I mean, one, affordability was and still is a top concern for regulators and legislators. And access to GLP1s were declining. Two drug shortages at the time exploded. Right. And the market was flooded with compounded non FDA approved alternatives, creating real safety risks. Three manufacturers were looking for a way to disrupt and we became that partner, starting with our partnership last year with Novo Nordisk for WeGovy and now with Eli Lilly. Together we've lowered costs, helped patients avoid unsafe alternatives, and addressed barriers to access and affordability.

[B]

And I wanted to hear some final thoughts and advice as we wrap up for other industry leaders. And I know you mentioned a lot about what centerwell does really well, but what advice do you have also for payers that might not have a pharmacy component and what they could be thinking about right now?

[C]

Yeah, if there were, if there's one takeaway from our experience, it's this. The GLP1 moment isn't just about GLP1s. It's about rethinking the entire ecosystem around access, affordability and consumer experience. My advice is simple, right? Start designing for the consumer. First, when you build models that prioritize transparency, clinical quality and predictable cost, you don't just improve access, you naturally bend the cost curve because the system becomes simpler. Second, leaning into partnerships, none of us can solve the drug affordability and access challenge alone. Manufacturers, pharmacies, payers and employers each control a different lever. So when those work together, like our collaborations with Eli Lilly and Novo Nordisk, you can really create access channels that are clinically responsible, financially sustainable and scalable. And then just finally embracing transparency and data. The organizations that win in this space will be the ones who can demonstrate real outcomes, drive medication adherence, and give payers and employers true line of sight into utilization and value. So that obviously requires openness, shared data, and a willingness to rethink long standing structures in the pharmacy supply chain. We're at a pivotal moment in healthcare and if we design with a consumer in mind, commit to responsible collaboration, and build models that are transparent by default, we can expand access to transformational therapies like GLP1s while keeping the system sustainable for everyone.

[B]

Well, thank you Bethany so much for joining us today. It was great to get a bit more context on your collaboration with Eli Lilly and to our listeners. If you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com Bethany, thanks again and have a nice day.

[C]

Thanks Liz, you too.