On-Benefit GLP-1 Access at Manufacturer-Direct Pricing
Contracted with both major GLP-1 manufacturers. Full on-benefit data integrity and compliance. Typical employers reduce GLP-1 spend 20% to 30%.
Average annual GLP-1 overpayment, per 5,000 covered lives.
GLP-1 per-member-per-month cost rose from $1.43 in 2019 to $24.59 in 2024, a 77% compounded annual growth rate. Five GLP-1 agents now account for 21% of total pharmacy coalition spend, up from 1% in 2020. The GLP-1 market is projected to reach $105 billion by 2030. This is a CFO-level concern and a CHRO-level problem.
Compounded annual growth in GLP-1 PMPM cost, 2019 to 2024
Share of total Rx coalition spend from five GLP-1 drugs (vs 1% in 2020)
New GLP-1 formulations in development
Maintaining the status quo costs the average 5,000-life plan roughly $3,000 per day.
See Your Savings
Enter your population and current GLP-1 economics. We will show you what on-benefit manufacturer-direct pricing looks like at your scale.
Your inputs
Your results
Get your detailed savings breakdown
We will email you a formatted summary of your results, assumptions, and methodology, along with a scheduling link.
The Three Approaches Employers Consider
Only one combines manufacturer-direct pricing with full on-benefit data integrity and compliance.
| Dimension | Traditional PBM Routing | Employer-Funded Card to Cash-Pay Site | ApalyRx On-Benefit Manufacturer Direct |
|---|---|---|---|
| Manufacturer-direct pricing | No | Yes | Yes |
| Claim integrates with plan | Yes | No | Yes |
| Applies to deductible / OOP max | Yes | No | Yes |
| Compliant with Manufacturer TOS | Yes | No | Yes |
| Taxable to Member / Plan | No | Yes | No |
| ERISA Claim Records | Partial | No | Yes |
| CAA 2026 Reporting Compliant | Partial | No | Yes |
| Detailed Claim Reporting | Partial | No | Yes |
| Rebate Transparency | No | N/A | Yes |
| Member Reimbursement Required | No | Yes | No |
| Stop-Loss Eligible Claims Data | Yes | No | Yes |
- Manufacturer-direct pricing
- Yes
- Claim integrates with plan
- Yes
- Applies to deductible / OOP max
- Yes
- Compliant with Manufacturer TOS
- Yes
- Taxable to Member / Plan
- No
- ERISA Claim Records
- Yes
- CAA 2026 Reporting Compliant
- Yes
- Detailed Claim Reporting
- Yes
- Rebate Transparency
- Yes
- Member Reimbursement Required
- No
- Stop-Loss Eligible Claims Data
- Yes
Employer-funded card programs routed to manufacturer consumer sites typically violate manufacturer Terms of Use and create taxable income to members. Only on-benefit manufacturer direct combines the pricing with full regulatory footing.
How It Works
Member enrolls with ApalyRx
Enrollment runs off the plan's eligibility file. Portal access with SMS and email notifications.
Prescription sent to ApalyRx pharmacy
Prescriber sends the eRx through standard e-prescribing. No prescriber workflow change.
Member pays cost share
Cost share is set by the plan and collected through the ApalyRx portal.
Drug ships to the member's home
Cold-chain compliant manufacturer-direct fulfillment.
Claim adjudicates on-benefit at manufacturer-direct pricing
Plan receives full decision-level claim record. Member cost share applies to deductible and OOP max.
The GLP-1 program operates as a carveout outside your existing pharmacy benefit. ApalyRx does not replace your PBM or TPA. It is an addition, not a substitution. Your PBM continues to administer everything else in your formulary.
Manufacturer-Direct Pricing
Zepbound direct price
Wegovy direct price
Net cost at the point of dispense. No rebate receivables. No 90-to-180-day rebate float. No hidden spread. Plan receives full claim records and monthly reporting.
What Benefits Leaders Are Saying
As plan fiduciaries, we needed to demonstrate that every high-cost drug decision was documented and defensible. ApalyRx gave us decision-level records we had never had access to before, and a 25% reduction in our GLP-1 spend in the first year.
VP, Total Rewards · National Financial Services Firm
We had a PBM. We had a TPA. We had consultants. What we did not have was a single independent record that told us why a specific prescription was filled at a specific cost on a specific day. ApalyRx filled that gap, and gave our benefits committee the documentation it needed.
CHRO · Regional Commercial Bank
We did not switch our PBM. We did not overhaul our benefit design. We added ApalyRx for our GLP-1s and reduced our spend meaningfully without disruption.
VP, Benefits and HR Operations · Multi-Site Healthcare System
Contracted with the Two Major GLP-1 Manufacturers
ApalyRx is contracted through both major GLP-1 manufacturer employer-direct programs, covering the full branded GLP-1 weight management category available to employer plans in the United States.
Coverage spans both leading branded GLP-1 weight management therapies, tirzepatide and semaglutide, through their respective manufacturer employer-direct programs.
ApalyRx is the drug program administrator for both programs.
Built for Fiduciaries
ERISA fiduciary duty is personal. In 2024, class action lawsuits were filed against Johnson and Johnson, Wells Fargo, and JPMorgan Chase, naming individual benefits committee members as defendants. CAA 2026 codified rebate pass-through as the statutory default and gave fiduciaries a federal basis to enforce it. A GLP-1 carveout decision is a fiduciary decision.
ERISA Fiduciary Integrity
Decision-level claim records for every script. Seven-year retention. Audit-ready documentation.
CAA 2026 Alignment
Transparent contracted pricing, pass-through economics, auditable agreement terms.
Manufacturer Terms Compliant
Operates inside manufacturer employer-direct program terms, not through consumer cash-pay channels.
The 60-Day Path
Executive briefing
30-minute session. Review current GLP-1 spend.
Savings analysis
Drug-by-drug projection delivered.
Configuration and launch
ApalyRx runs integration, notifies your PBM, and configures program rules.
First savings clear
Dashboard active from day one.
Frequently Asked Questions
No. The GLP-1 program is a carveout outside your pharmacy benefit. Your PBM and TPA relationships are unchanged.
Direct shipment to the member's home, cold-chain compliant, tracked.
The dispensing pharmacy provides pharmacist consultation. Members retain their existing clinical care relationships.
Self-funded employers from 500 to 50,000+ covered lives.
Seamless transition through a defined enrollment window.
Consumer cash-pay sites are intended for self-paying individuals. Employer-funded card programs routed through those sites typically violate manufacturer Terms of Use and create taxable income events. The ApalyRx program is structured as an on-benefit carveout with adjudicated claims.
Yes. The platform supports manufacturer-direct routing for additional therapeutic categories. GLP-1 is the most common entry point.
Claims integrate with plan reporting so carriers receive standard claim data.
Start With Your GLP-1 Spend
Share your current GLP-1 spend and we will produce a specific, population-based savings analysis.
No disruption to your PBM, your TPA, your Members, or your benefit design.