What direct-to-employer GLP-1 purchasing means for primary care physicians

GLP-1s went from diabetes drugs to blockbuster weight-loss treatments in just a few years, and almost as quickly, filling a prescription for one ran into a familiar gauntlet: the employer's health plan, a pharmacy benefit manager (PBM), a prior authorization and, often, a denial. A small but growing group of companies is now trying to route around that process, selling brand-name drugs straight to employers that pass the discount to their workers, with no insurer or PBM in between.

What is direct-to-employer drug purchasing?

Andel, which launched its medication platform in March 2026, is one of them. In the company’s own words, it’s a cooperative that aggregates demand across employers, buys directly from drug manufacturers at a discount and lets employers add a cash contribution to lower what an employee pays at the point of sale. Its first drug was Eli Lilly's Zepbound KwikPen, and founder and CEO Jay Bregman says the model is built to expand well beyond weight-loss drugs.

Andel isn’t operating in a vacuum. Eli Lilly and Novo Nordisk have each rolled out their own direct-to-employer and cash-pay channels for their branded GLP-1s, and a field of benefit vendors and aggregators has grown up around the same idea. Fewer than 20% of employers with 200 or more workers covered GLP-1s for weight loss in 2025, according to KFF's annual employer benefits survey, even as demand has continued to climb.

How does direct-to-employer drug purchasing work for the prescribing physician?

For physicians, the most obvious question is a practical one — what actually changes day to day? By Bregman's account, very little on the front end.

Because Andel operates a licensed pharmacy connected to the Surescripts network, a physician sends the prescription the same way they would to any retail pharmacy, and the fill flows into the patient's record through the same e-prescribing rails. Andel's pitch to clinicians leans on what is removed rather than added: no prior authorization, no step therapy, no utilization management standing between the prescription and the fill.

What should physicians watch for with direct-to-employer GLP-1 programs?

Access under these models is tied to a job and an employer's willingness to keep paying. Bregman acknowledges that for some drugs, once an employer's contribution runs out or a patient leaves the job, the negotiated price can disappear. He says the Consolidated Omnibus Budget Reconciliation Act (COBRA), may allow some plans to continue the benefit and that portability between employers is on the company's roadmap, but the cliff is real today for at least some medications. For a physician managing a patient on a GLP-1, that turns continuity into something partly outside clinical control, and most patients who stop these drugs regain weight.

On one common critique of cash-pay channels, Andel's design cuts the other way. Because the prescription originates with the patient's own physician and travels through Surescripts, the fill lands in the medical record like any other order, and the company says it also gives plans a free data feed so out-of-pocket spending and accumulators can be reconciled.

Bregman casts that as the dividing line from direct-to-consumer, where "everybody's on their own." How well the data exchange performs in practice is not yet something an outside party can verify.

The harder concern is cost, not visibility. Benefits advisers note that when patients face an unpredictable out-of-pocket burden, stop-and-start use can undercut adherence and complicate side-effect management, which is part of why the access cliff matters in the exam room and not just the benefits office.

None of this is settled — the platform is relatively new and the broader shift toward employer- and plan-driven drug purchasing is early enough that its effect on continuity of care and total spending is still being measured.

What is clear is that the model is already reaching commercially insured, working-age patients, the core of most primary care panels, at a moment when the new Medicare GLP-1 Bridge, set to begin July 1, extends $50-a-month access only to eligible Medicare Part D beneficiaries and runs out at the end of 2027.

Related content: What physicians need to know about Medicare's new obesity drug coverage, with Tracy Zvenyach, Ph.D., M.S., RN, of the Obesity Action Coalition

Medical Economics sat down with Bregman to understand how the model works, where it fits and what it means for the physicians whose patients are starting to encounter it.

Our full conversation, lightly edited for length and clarity, follows.

For physicians who are hearing about direct-to-employer drug purchasing for the first time, could you walk through what it is and what gap it's trying to fill?

Jay Bregman: Sure. Andel's model, and we really pioneered the direct-to-employer category, is that we acquire the rights to expensive brand drugs directly from the manufacturer at a significantly lower price. We earn that price because on our marketplace there's no utilization management, no prior authorizations, no formularies and no rebates.

We then contract with employers directly, who pay us a cash contribution, as little as $100 per fill, as much as 100% of the fill, and then carve out their drugs from their traditional plan. They let their members know that they're contributing to the medications, but not in the traditional way.

Members send their scripts to the Andel pharmacy. We process them and manage eligibility. We send a message to the member once the prescription is confirmed, the member downloads one of our apps, they pay net of all the discounts and contributions, and the medication gets shipped to them the next day at a massively lower price.

Why have GLP-1s in particular become the entry point for this kind of model?

There are a couple of different phenotypes that are appropriate, or more appropriate, to direct-to-employer. Ultimately we think it's applicable to almost anything. GLP-1s have such high utilization that they have really broken the traditional model for coverage.

They're the wildfires and hurricanes of pharmacy. It's just impossible to cover them, because so many people want them at almost any cost. So they've fundamentally come into this category where, if you want to provide some form of benefit, it has to be a different type of benefit than the traditional pharmacy benefit. That's why they've been carved out, and that's why they've been an effective candidate for direct-to-employer.

Because so many plans now are exploring and implementing direct-to-employer for GLP-1s, they're effectively putting in place the scaffolding for many other drugs to be put under this alternative direct-to-employer benefit as well.

Walk us through the process: What actually happens when an employee gets a GLP-1 medication through Andel, from the prescription to having the drug in their hands?

Sure. With Andel it is extremely seamless. The members keep their own trusted doctors, their own trusted providers. They don't have to change. There's no telehealth, limited networks, etc. Their existing provider sends the script to the Andel pharmacy. The Andel pharmacy is a non-dispensing pharmacy. We're on the Surescripts network, we're in every EMR in the country, so it's really easy.

Doctors don't have to do anything differently. Once we get the script, everything is completely automated: the eligibility management, the communication to the member, the member downloading the app, the fact that the member can pay via HSA, FSA, or just credit card or debit card. And then they receive the medication conveniently in the mail, as soon as the next day.

Where does the physician fit in this process? Does the prescription still start with the patient's doctor?

What's so great about the Andel model is we are really just re-empowering the prescriber. In this day and age, so many forces have acted to take away, and to add administrative burden to, prescribers.

Prior authorizations, utilization management: they don't add any clinical value. Let's face it, they're really designed to protect formularies and costs and other kinds of things. So we've chosen a different model, where the provider makes the decision about what drug to prescribe, and once that drug is prescribed there is a contribution level, set by the plan, that is fair and consistent.

The member pays that contribution level and then they're dispensed the drug. There's no other admin in between. So all of the costs that the plans have been paying for prior authorizations and utilization management, they're gone.

Is there anything a physician has to do differently in this model?

That's the great thing. We've chosen to do the extra hard work to build our own pharmacy, our own NPI, our own Surescripts integration, because we're integrated into the Surescripts network, which has 100% of US prescribers present on it.

They don't need to do anything differently.

Any EMR in America has the Andel pharmacy. They search for it, they send the prescription as they would to any other pharmacy, and that's it. We handle the rest.

Will the medication still show up in the patient's records the way a normal prescription would, so the physician has a full picture of what the patient's taking?

Absolutely, because this is being sent from the prescriber's EMR via Surescripts. All of the data is there. But it gets better: we provide a free data exchange API to plans, PBMs and carriers, so the plan itself can maintain information about the out-of-pocket that's being paid by the member, they can reconcile accumulators or deductibles, and the plan will retain a complete picture of the health of the member, even though this is provided under a non-traditional means.

That's something you don't get with direct-to-consumer. With direct-to-consumer, everybody's on their own, there's no data, deductibles aren't counted. It's really the wild, wild West.

For patients, how does the cost and the overall experience compare to getting a GLP-1 through the regular pharmacy benefit?

First of all, let's be clear: I think less than 2% of people in any given plan are actually getting access, even when plans do cover GLP-1s, because there's massive utilization management, massive prior authorizations. People just give up. And by the way, even if you do manage to get your plan to cover it, just wait until next year, because maybe, maybe not. It's a real crapshoot.

With our platform, the member gets a predictable, transparent price. The out-of-pocket they're paying is going to be the same or lower each month, and they're going to be getting it through a consistent system and platform. So the member is getting a much better, more consistent experience than they're getting with the traditional reimbursement or insurance system, which just isn't reliable for these kinds of drugs.

What happens to a patient's access if they leave the job or the employer drops the benefit? And is there anything a physician should keep in mind about that process?

At Andel, we think about this, and we are working on this. There are a couple of different things to know. One is COBRA: if somebody leaves their job and they're eligible for COBRA, we have confirmed with our providers, with the medicines on our network, that the plan may choose to continue giving them the benefit under COBRA, which is a huge deal.

The second is, we are trying to develop, in the future, ways that you can port your Andel membership from one employer to the next, and even see which employers actually support Andel, so that might be a factor you use in deciding whether to choose one employer over the next.

But for now, for certain drugs, depending on the drug and the manufacturer, unfortunately, once the contribution from the plan runs out, you're not able to access that price anymore. But like I said, that's something that we don't believe is currently fair, and we absolutely want to change.

Where does Andel's model fit relative to Medicare’s new GLP-1 Bridge?

Medicare has always been its own thing. None of the Andel products currently are designed to be sold on Medicare. I think we should celebrate all of the access that is going on in Medicare. It is a separate, government-funded program. But we're focused on the mainstay of the market, which is the commercial market, effectively everybody else, and how do you improve that for the hundreds of millions of people who are not in Medicare?

What's one thing you want physicians to understand about this model?

One of the things I want them to understand is that help is coming. My father was a heart surgeon, and he lamented about this, but every physician laments about the increasing amount of admin that has been forced on them by insurance companies, by PBMs and so on. It adds no clinical value at all. It's gatekeeping after gatekeeping, roadblock after roadblock. What they need to know is that help is on the way.

One of the key tenets of the Andel platform is that the prescriber knows best, and so we respect the prescriber's decision. We don't challenge it with a prior authorization, we don't challenge it with utilization management, because what do we know? And frankly, what does the insurance company know either?

Is there anything else you want physicians to keep in mind?

The main thing is that Andel is not just a service for GLP-1s. We signed agreements yesterday for our first non-GLP-1 medication, which will be announced in the coming weeks, and ultimately I think in the next six months you're likely to see dozens of new medications come onto the Andel platform.

What we would really like is to build a dialogue and a relationship with prescribers, so that we know what they like about the Andel platform, what they don't, and how we can make it better and easier and quicker for them. They can go on our website, or they can look me up on LinkedIn.