Employers are testing new cost‑control models.
Employers are increasingly buying high‑cost brand drugs directly from manufacturers, bypassing traditional pharmacy benefits and the insurers that usually manage them. The shift, known as direct‑to‑employer purchasing, changes where prescriptions are routed, what patients pay and who handles the benefit once an employer’s contribution ends.
How the new model works
Andel, a cooperative marketplace founded by Jay Bregman, connects health plans, drug makers and members on a single network. The company acquires rights to brand medicines at a discount by eliminating utilization management, prior authorizations, formularies and rebates. Employers then make a cash contribution—anywhere from $100 per fill up to the full price—and carve the medication out of the standard plan.
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When a physician writes a prescription, the script is sent through Surescripts to Andel’s non‑dispensing pharmacy. Eligibility checks, payment processing and shipping occur automatically, without requiring telehealth visits or a limited provider network. A free data‑exchange API lets the plan reconcile out‑of‑pocket spending and accumulators, ensuring that the transaction appears in a patient’s chart like any other prescription.
Impact on patients and providers
According to Bregman, fewer than 2 percent of members actually obtain access to GLP‑1 drugs even when a plan lists them as covered. Predictable monthly costs are preferable to an approval that may not survive the next plan year. The model also removes an administrative layer that never added clinical value, effectively returning decision‑making power to the prescriber.
Physicians do not need to change their workflow; the integration appears in any electronic medical record, and the script is processed as it would be for a retail pharmacy. The order travels through Surescripts, reports back to the provider and, thanks to the data exchange, allows the plan to track patient spending without extra effort.
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When an employee leaves a job, the situation becomes less clear. For certain medications the negotiated discount disappears once the employer’s cash contribution stops, leaving the patient to face higher out‑of‑pocket costs.
From a broader perspective, this approach reflects a growing trend of employers taking a more active role in managing prescription costs. By negotiating directly with manufacturers, they aim to secure lower prices and provide a more stable financial experience for their workforce. Yet the model raises questions about continuity of care and equity, especially for workers who change jobs or lack alternative coverage.
For prescribers, the key takeaway is that the platform treats the clinician’s decision as final, without challenges from prior authorization or utilization management. Bregman encourages physicians to give direct feedback as the service expands beyond GLP‑1 drugs, hoping that the streamlined process will improve patient access while reducing administrative burdens.
