The Next Evolution of Pharmacy Access Models

Traditional coverage approaches for high-cost therapies continue to fall short of what employers and patients need. Prior authorizations and rebate-centric payment structures weren’t built for the pressures employers face today, and they now create more friction than value.

The replacement framework already exists. It’s built on pricing directly from manufacturers, an employer’s intentional plan design, and properly aligned incentives, and it’s giving employers real control over both costs and employee experience.

The Access Problem Employers Can’t Ignore

Employers are under pressure trying to maintain employee satisfaction and keep costs under control. Employees want these therapies, but the cost of providing access compounds quickly. Newer medications often mean more expensive medications, and traditional management approaches can’t keep up with this level of demand or cost complexity. These tactics also add unnecessary strain to those involved. Employees experience delays or confusion while awaiting authorization, while employers deal with opaque pricing structures.

As demand increases, especially in weight management therapies, the cracks in the system need to be addressed. More restrictions are not the answer; the model itself needs to be redefined. A well-designed solution preserves employee access while eliminating the cost volatility that makes these medications so difficult to manage and plan for.

The proof is already here. In 2026, Waltz clients are on pace to reduce GLP-1 spend by 60–70% year over year while still providing employee access. That translates to $5–$10 PMPM across all covered lives.

A Better Way to Structure Access

The direct-to-employer access model doesn’t restrict access; it restructures it. We’ve built this model to eliminate the cost and operational barriers that force employers into restriction in the first place.

A key difference in this approach is employers maintain full visibility into what is being prescribed and how much it costs at the time of dispensing. This provides more data and helps employers make informed decisions over time. For employees, the model removes unnecessary friction and enables cost clarity with real-time pricing. This is how you can preserve access, satisfy employees, and control costs – without sacrificing any one of them.

Why the Direct-to-Consumer Channel isn’t Enough

Direct-to-consumer (DTC) options may appear straightforward, but they come with significant downsides, especially from an employer’s standpoint.

DTC models sit outside the benefit, and that gap costs employers valuable visibility and control into the wholistic health of their employees. Employers lose insight into how therapies are being used, making it nearly impossible to manage costs, understand what’s driving them, or guide behavior through their plan design or aligned incentives.

Even though the DTC experience looks better for an individual employee over time, it provides no framework for controlling costs across a population.

The direct-to-employer model provides convenience within a structure that is manageable and scalable. It isn’t a compromise; it’s a more informed solution. Employees get the access they want, while employers keep the visibility needed to maintain the system.

Built for What Comes Next

The current demand is centered around GLP-1s, but this shift applies beyond any single drug category. It’s a flexible and repeatable way to manage high-demand, high-cost therapies overall. As new treatments come to market, the same challenges of the traditional coverage model will keep showing up.

The next category is already on the horizon. Employers who build a durable access framework today will be far better positioned to absorb that demand. Those who do not will face the same reactive scramble all over again.

It’s not just about solving today’s problem, but a broader evolution. We help employers build a better foundation so they are ready for whatever comes next, with access intact, costs in check, and a better experience for everyone in the system.

Ready to see what this model can do for your organization? Contact us to start the conversation.