Speaker 0: This is where health insurance leadership comes together. Becker's fourth annual spring payer issues roundtable brings 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 and click on the events tab in the upper right.

We're looking forward to hosting you here in Chicago.

Speaker 1: 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.

Speaker 2: Yeah. Happy to be here. Thanks for having us, Liz.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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.

Speaker 2: 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.

Speaker 1: 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.

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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.

Speaker 2: Thanks, Liz. You too.