Tirzepatide is the first GLP-1 with an additional mechanism of glucose-dependent insulinotropic polypeptide (GIP) receptor agonist and is used for the treatment of type 2 diabetes and chronic weight management. The dual GLP-1/GIP mechanism of action is thought to be an enhanced GLP-1, with greater effects on blood sugar control and weight management.

Semaglutide is used to treat type 2 diabetes and chronic weight management. It is a glucagon-like peptide-1 (GLP-1) receptor agonist, which means it mimics the effects of the natural hormone GLP-1.  Semagltuide has been shown to be effective in lowering blood sugar levels and aiding in weight loss. 

Compounded GLP-1s are typically supplied in multi-dose vials and measured using a syringe. Brand products are supplied as prefilled pens devices. 

In addition to controlling blood sugar and promoting weight loss, some GLP-1 medications have kidney and heart benefits, such as reducing the risk of heart attack and stroke. There is ongoing research into new indications and beneficial uses of GLP-1s. 

The most common side effects of compounded GLP-1s are similar to the commercial GLP-1s, and include nausea, abdominal pain, constipation, and vomiting. These side effects are typically mild and usually go away over time as the body adjusts to the medication. It is important that patients consult with their provider regarding the use of compounded GLP-1s. 

Compounded medications can be used, in situations when a specific medication must be made for one person (e.g., due to an allergy to an inactive ingredient contained in the brand or generic version of a drug), or when drugs are on the FDA’s Drug Shortages list to ensure you have access and  can continue taking your medication for treatment. 

Compounding pharmacies that meet the requirements of the Federal Food, Drug, and Cosmetic (FD&C) Act and use the base formulation–not the salt form– use the same active ingredients as semaglutide commercial products. 

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GLP-1s may be prescribed by providers for diabetes and obesity. With the rising demand, there are also direct-to-consumer options for weight loss. 

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Alarmingly, 38% of respondents of a 9amHealth study³ have tried knock-off GLP-1s/semaglutide or black market weight loss products, greatly increasing the risk of complications or adverse reactions as these drugs could contain contain too little, too much or no active ingredient at all, or contain the wrong of other harmful ingredients.  The FDA recommends that individuals should only get compounded semaglutide from state-licensed pharmacies or outsourcing facilities registered with FDA.⁴

According to a study by PSG², the top cost containment strategies are prior authorization, Body Mass Index (BMI) requirement, quantity limits, comorbid condition requirement, step therapy, and lifestyle modification program participation requirement.

GLP-1 therapies, first approved in 2005, have been part of the pharmacy landscape for nearly two decades. Recently, their demand has surged due to their effectiveness and benefits, such as treating obesity and reducing cardiovascular risks. GLP-1s are also being studied for treating various chronic diseases like heart failure, obstructive sleep apnea, and liver disease. Their future growth is expected to continue, driven by their efficacy and safety, the rising prevalence of diabetes and obesity, and new FDA- approved indications, likely making them a significant driver of employer plan sponsors’ pharmacy benefits spending.

As of July 2024, due to increased demand, there is a FDA nationwide shortage of GLP-1 medications (specifically, Semaglutide injections and Tirzepatide injections). To ensure continued access to medications on the FDA’s Drug Shortages list, compounded versions using the same active ingredients may be made during such shortages under certain conditions and state and/or federal requirements.

Glucagon-like peptides-1 receptor agonists (GLP-1s) and Glucose-dependent Insulinotropic Polypeptide receptor agonists (GIP) are medications that mimic hormones naturally produced by the body. When referring to ‘GLP-1s', this includes GLP-1s and dual GLP-1s/GIPs. The Food and Drug Administration (FDA) has approved several GLP-1s to treat type 2 diabetes, obesity, and reduce the risk of cardiovascular disease.

Pharmaceutical Strategies Group (PSG) reported¹ that nearly 80% of health plans and employers respondents were moderately or very concerned about the affordability of GLP-1s. According to the same PSG report, 91% of health plans and employers currently cover GLP-1s for type 2 diabetes, while 33% cover them for obesity.

Pharmacy benefit managers, or PBMs, are companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers. By negotiating with drug manufacturers and pharmacies to control drug spending, PBMs have a significant behind-the-scenes impact in determining total drug costs for insurers, shaping patients’ access to medications, and determining how much pharmacies are paid. PBMs have faced growing scrutiny about their role in rising prescription drug costs and spending. Reference

If you are on vacation and are in need of medication (because medicine was forgotten or you ran out), there are a number of options depending on where you are vacationing and what medicine(s) you need. Often, the best solution is to have a pharmacy near you contact the pharmacy where you normally fill prescriptions to transfer the prescription to refill there. If it is too soon to refill, in order to avoid running out of medicine, you can call our customer service number at 844-454-5201, and we can work with you to find a solution.

Filling and delivery of mail order prescriptions, both new and refilled prescriptions, are managed by the mail order pharmacy contracted with your insurance plan. For the most up-to-date status of a mail-order prescription or delivery, you can call the mail order pharmacy directly. If you have any trouble calling the mail order pharmacy, you can also call our customer service number and a member of our team can coordinate with the mail order pharmacy to help you with a status update.

Auto-fill (or auto-refill) is a convenient and time-saving option for most of your mail order prescriptions. Opting-in for auto-refill may allow you to maintain consistency in taking your medications. As such, it is a great option for chronic medicines that you take regularly and are important to take consistently. For medicines not on auto-refill, you would need to order each refill, requiring you to plan and call early to allow enough time before you run out of medicine. For prescriptions on auto-refill, instead of contacting the mail order pharmacy each time you need a refill, the medicine is automatically refilled and delivered to you according to your prescription schedule. To place a prescription on auto-refill, you will need to call your plan’s mail-order pharmacy to opt-in for each prescription that you would like on auto-refill. If at any time your doctor stops a medicine that was on auto-refill, please call the mail order pharmacy to let them know that you are no longer taking this medicine to avoid being charged and sent medicine you no longer need.

Quantity Limits specify a maximum dosage or quantity that will be covered (for example, a maximum number of tablets per day). These quantity limits often reflect safe and effective doses for a given medication. Any dosing (reflected in quantity per day) up to the quantity limit will be covered, but dosing quantities above the quantity limit will be initially rejected. In order for any prescription exceeding a formulary quantity limit to be covered, the prescribing doctor will need to apply for a prior authorization, providing medical justification for the higher dosing to be reviewed by our clinical team.

Sometimes you can’t use your pharmacy benefits when you’re at the pharmacy. If that happens, you can download the reimbursement form from your member portal account and submit it to us and we’ll help you get your money back. If you’re not registered, call our customer support team at 844-454-5201 and we can email the form to you and answer any questions about the process. Reimbursement for these prescriptions will be based on your benefit plan design.

Register for a secure SmithRx account at: https://mysmithrx.com/. From the member portal, you can look up medications and see your out of pocket costs. Members can find in-network pharmacies from our national network of over 70,000 participating locations. Download mail order and prior authorization forms, review claims and find employer specific customer service contact information for any of your pharmacy service needs.

Generic, Preferred Brand, and Non-Preferred Brand drugs refer to classifications of drugs that correspond to Tiers (Tier 1 through Tier 3) in your prescription benefits plan. Copay, in addition to other factors such as day supply of the prescription, is determined by the drug’s tier. Your prescription drug plan may designate certain brands as preferred (typically Tier 2) and some as non-preferred (Tier 3). Brand name drugs tend to be more expensive. Generic versions of those brand name drugs have the same active ingredients but tend to be less expensive. For example, Tylenol is a brand drug and acetaminophen is its generic equivalent.

Use our mobile site to securely and easily manage new prescriptions. All of your member information is included in a handy electronic ID card.

Log on to your member portal for quick access to the information and instructions to fill your prescription. To reorder your ID card, call SmithRx at 844-454-5201 or submit a card request form.

Step Therapy is a condition in which certain drugs require other medications to be tried before they can be covered by insurance. Step Therapy may have one or more levels of criteria (steps) that must first be fulfilled. If your doctor prescribes, or wants to prescribe, a medication that requires step therapy, he/she can call 844-512-3030 to work with our clinical team to coordinate therapy and determine what is needed.