Question 1

Why should employers invest in diabetes and metabolic health management?

Accepted Answer

Diabetes and prediabetes affect 37 million and 96 million Americans respectively, and are among the top cost drivers for employer health plans. Employees with diabetes cost employers 2–3x more in healthcare than employees without diabetes. Effective diabetes management programs reduce A1C levels, prevent complications (kidney disease, neuropathy, cardiovascular disease), reduce hospitalizations, and lower total healthcare costs. Employers typically see $3–$5 ROI for every $1 invested in diabetes management.

Question 2

What is the difference between a diabetes management program and a GLP-1 management program?

Accepted Answer

A diabetes management program focuses on helping employees with Type 2 diabetes manage their condition through lifestyle coaching, medication adherence, continuous glucose monitoring (CGM), and care coordination. A GLP-1 management program specifically manages the use of GLP-1 receptor agonists (Ozempic, Wegovy, Mounjaro) for diabetes and obesity, including prior authorization, clinical criteria, lifestyle support, and cost management. Many vendors now offer integrated programs covering both diabetes management and GLP-1 oversight.

Question 3

How do continuous glucose monitors (CGMs) help employers manage diabetes costs?

Accepted Answer

CGMs provide real-time blood glucose data that helps employees with diabetes make better decisions about diet, exercise, and medication. CGM programs reduce A1C levels by 0.5–1.5 percentage points, which translates to significant reductions in long-term complications and costs. CGMs also identify prediabetic employees who can benefit from prevention programs before developing Type 2 diabetes. Employer CGM programs typically cost $50–$150 per participant per month and show positive ROI within 12–24 months.

Question 4

What should employers look for when evaluating diabetes management vendors?

Accepted Answer

Key evaluation criteria: clinical outcomes data (A1C reduction, weight loss, medication adherence), program model (app-based vs. care team, CGM integration), population identification (how do they identify eligible employees from claims data), engagement rates (what percentage of eligible employees enroll and stay engaged), GLP-1 management capabilities, integration with your TPA and PBM, and employer reporting. Request peer-reviewed outcomes studies and references from current employer clients.

Question 5

How do employer diabetes programs integrate with the pharmacy benefit?

Accepted Answer

Diabetes management programs integrate with the pharmacy benefit through: PBM data feeds (identifying employees on diabetes medications), formulary management (ensuring preferred diabetes medications are covered at low cost-sharing), specialty drug management (managing GLP-1 costs through prior authorization and step therapy), and medication adherence programs (outreach to employees who are not filling prescriptions). Strong PBM integration is essential for diabetes program effectiveness — confirm integration capabilities before selecting a vendor.

Diabetes & Metabolic Health Vendors