Can direct-to-employer models close the GLP-1 obesity care gap?

Disclaimer: pharmaphorum and Waltz Health share the same parent company.

Helping employees access affordable healthcare has long been a source of tension for HR leaders caught between managing rising costs, evolving workforce expectations, and the need to remain competitive on benefits.

Few areas illustrate this tension more evidently than the rapidly evolving obesity space. Breakthrough medicines, such as Wegovy and Zepbound, have reshaped both clinical expectations and employee demand, with growing numbers willing to change jobs in search of coverage. Against this backdrop, direct-to-employer (DTE) approaches are gaining traction as a way to reduce complexity and tailor support to workforce needs.

To find out more, we spoke to Deanna Horner, SVP and chief pharmacy officer at Waltz Health, which recently announced its own DTE initiative, to learn what this shift really means for patient access.

From your perspective, what are the biggest pressures and challenges employers are facing today when it comes to providing access to high-cost, high-demand therapies like GLP-1s for obesity management?

Employers are facing mounting pressure from high-cost therapies driven by unpredictable, concentrated spend, rapid growth in specialty costs, fragmented ecosystems, limited pricing transparency, and misaligned incentives – all compounded by uncertain return on investment due to workforce turnover and tightening stop-loss markets. As a result, they are being forced to actively manage access, affordability, and employee expectations within an increasingly complex and clinically intensive environment.

We're hearing more about emerging "direct-to-employer" access models. At a high level, how does this approach fundamentally differ from the traditional, rebate-driven PBM systems that have long dominated the market?

The direct-to-employer (DTE) access channel represents a fundamental shift from employers operating as indirect purchasers within opaque, rebate-driven systems to becoming direct buyers of care with visibility into total cost, including drug pricing and associated fees. This improves forecasting and benefit design while enabling direct negotiation, site-of-care optimisation, and outcomes-based approaches. However, it also introduces risks around fragmentation and integration with existing PBM and medical systems. Choosing a DTE partner that can integrate with the existing ecosystem is essential.

The traditional pharmacy supply chain is often described as complex and "opaque." How do these more direct models bring clarity to drug pricing, and why is that financial transparency a game-changer for a self-insured employer's strategy?

DTE models simplify the traditional supply chain by removing or reducing opaque elements like spread pricing, rebates, and hidden fees, providing a clearer view of true net cost across the full episode of care. This fundamentally shifts employers from passive payers to informed purchasers, enabling better forecasting, stronger vendor accountability, and more value-based decision-making. Transparency becomes the foundation for aligned incentives and more sustainable benefit strategies.

While affordability is critical, how do these new models impact the employee experience?

While affordability is a key driver, DTE models can significantly reshape the employee experience. When executed well, they offer a more guided, concierge-like journey with faster access, clearer pathways to care, and integrated support, reducing friction in a traditionally complex process. However, without strong integration, they can introduce new friction points, such as multiple vendors or unclear entry points, leading to fragmentation. Ultimately, success depends on delivering a seamless, well-coordinated experience to the employee.

Can you speak to the importance of integrating clinical support and ensuring a seamless journey for patients seeking treatment?

Clinical integration is essential to unlocking both the clinical and financial value of high-cost therapies. These treatments require coordinated patient identification, provider alignment, onboarding, and ongoing monitoring. Without integration, patients face delays, inconsistent guidance, and higher discontinuation rates, driving poor outcomes and wasted spend. A coordinated, end-to-end model ensures patients receive the right therapy, at the right time, in the right setting, improving outcomes while reducing avoidable costs.

With rising demand for medications (such as GLP-1s), how can employers ensure that access is managed in a clinically responsible way?

Employers need to implement clinically grounded access frameworks that ensure appropriate use while controlling cost. DTE models support this by creating structured, transparent pathways to care through curated provider and pharmacy networks with aligned clinical protocols. This reinforces evidence-based use, while integrated support, such as coaching and monitoring, improves adherence and outcomes. Employers can also apply outcomes-based continuation criteria to ensure therapies deliver sustained value over time.

What role should clinical safeguards and eligibility criteria play in a well-designed programme?

Clinical safeguards are foundational to ensuring access is appropriate, consistent, and value-driven. Evidence-based eligibility criteria help identify the right patients, while standardised care pathways, provider alignment, and outcomes-based continuation criteria ensure therapy remains effective over time. In a DTE model, these safeguards also create accountability across stakeholders, ensuring spend is directly tied to real clinical value.

Looking ahead five years, how might the success of direct-to-employer models for obesity management influence how other high-cost, specialty medications are covered and accessed in the employer-sponsored market?

Successful DTE models in obesity will accelerate a broader shift from passive reimbursement to active, value-based purchasing of care. Employers will increasingly demand end-to-end, condition-specific solutions that bundle drug access with clinical support and measurable outcomes. At the same time, manufacturers are already expanding DTE approaches into areas like immunology, neurology, and cardiovascular renal metabolic. As the model evolves, it will drive wider adoption of transparent pricing and integrated care delivery, positioning obesity as the proof point for scalable, employer-directed access models.

Which quality, access, and experience metrics have proven most effective in aligning incentives and avoiding unintended consequences?

The most effective metrics link clinical quality, access, and patient experience into a balanced, outcomes-focused framework. This includes clinical outcomes and adherence, timely and equitable access, and patient-reported experience. When measured longitudinally and at the condition level, these metrics ensure appropriate, effective care while avoiding under-treatment, overuse, and fragmentation, ultimately tying spend to measurable value.

If you were advising an employer or health system doing this for the first time, what are the top three things you would tell them to focus on in year one?

Year one should focus on three priorities: First, establish a seamless front door and navigation experience to avoid fragmentation. Second, define clear clinical guardrails and success metrics to ensure appropriate use and measurable value. Third, start with targeted, high-impact use cases while building scalable data and integration capabilities. Getting these foundations right enables early wins and positions the model for broader, sustainable expansion.

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About the interviewee

Deanna Horner serves as SVP and chief pharmacy officer at Waltz Health where she focuses is on harnessing provider and payer expertise to revolutionise the prescription drug marketplace. With experience across hospital, health system, and managed care industries, prior to this position, Horner held various leadership roles at UnitedHealthcare, including chief pharmacy officer for government programmes and vice president of clinical and specialty programmes.

About the author

Eloise McLennan is the editor for pharmaphorum’s Deep Dive magazine. She has been a journalist and editor in the healthcare field for more than five years and has worked at several leading publications in the UK.

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