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together over 400 payer and health plan executives
and more than 100 speakers to Chicago April.
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
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here in Chicago.
Hello, everyone. This is Elizabeth Cassello 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. Yeah. Happy to be here. Thanks for
having us, Liz.
Yeah. So before we jump into the conversation,
can you tell us a little bit more
about yourself, your health care career background,
and what your role is at Humana?
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.
That's great to hear, Bethany, and thanks again
for joining us.
So the big news I wanna talk about
today is how Humana Centerwell 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 GLP one coverage, and how
does this partnership
enable Humana to respond to that demand?
Yeah. Thanks, Liz. I love this question. I
think employers are in a very different place
with GLP one 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 GLP one 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 GLP ones 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. Right? 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, like, the cost pressures are
real. Right? A recent Gallagher study showed that
GLP one drug class spend increased 35%
in 2024
and another 25%
in 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 clear 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 employer structure GLP one
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.
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, we go via access.
And there's also just beyond that, some recent
research points to slowed medical cost growth for
g l p GLP one 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.
Yeah. I would just say, I think GLP
ones 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 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? CenterWell 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 thirty years, we've operated with no hidden
fees, no gains, and complete visibility for the
health plan.
And then lastly, affordability
is just built into our model. Right?
At at the highest level, 90% of our
generics cost less than $2 a month, many
with no co pay 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 that
with home delivery
scale and a consumer first mindset,
you really end up with a pharmacy model
that is uniquely aligned to what the GLP
one 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 GLP ones. 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 and it's built to support the next
generation of therapies at scale.
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 what else do you have to
say on adherence?
Because that is just such a big concern
in terms of the cost here.
Yeah. I totally agree. And if you 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.
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.
Yeah. Absolutely. And you mentioned this earlier, but
you think that employees are
shifting their perspectives on GLP ones 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?
Yeah. It's it's a great question.
The health care system is under pressure to
lower drug costs and expand access. Right? 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, GLP ones 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 GLP ones
were declining.
Two, drug shortages at the time exploded. Right?
And the market was flooded with compounds and
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.
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?
Yeah. If there were
if there's one takeaway from our experience, it's
this. The GLP one moment isn't just about
GLP ones. It's about rethinking the entire ecosystem
around access, 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 this 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 health care,
and if we design with the consumer in
mind, commit to responsible collaboration,
and build models that are transparent by default,
we can expand access to transformational therapies like
GLP ones
while keeping the system sustainable for everyone.
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.
Thanks, Liz. You too.