GLP-1s broke the traditional pharmacy benefit, and a growing number of employers are responding by buying brand drugs straight from the manufacturer and cutting the insurer and pharmacy benefit manager out of the transaction entirely.

Jay Bregman, founder and CEO of Andel, joins Medical Economics Associate Editor Austin Littrell to explain how the model works from the prescriber's side: the script still starts with the patient's own physician, still travels over Surescripts and still reports back into the chart. What changes is everything after that, including a fixed employer contribution in place of a prior authorization.

Bregman also addresses the part that matters clinically, which is what happens to a patient's negotiated price when they leave the job or the employer stops contributing, and where a benefit built on employment leaves the patients it doesn't cover.

Music Credits:
Soft Morning by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:31 | Cold open Bregman on why coverage on paper rarely means access in practice, and why even an approval may not survive the next plan year.

0:31 – 1:40 | Introduction Austin Littrell introduces the episode and Jay Bregman, and frames direct-to-employer purchasing as one of several channels now routing around the pharmacy benefit.

1:40 – 2:06 | Meet Jay Bregman Bregman describes Andel as a cooperative marketplace connecting plans, drug manufacturers and members on a single network.

2:06 – 3:37 | What direct-to-employer purchasing actually is Andel acquires rights to brand drugs from the manufacturer at a discount, which Bregman says it earns by removing utilization management, prior authorization, formularies and rebates. Employers pay a cash contribution, from $100 per fill up to the full cost, and carve the drug out of the traditional plan.

3:37 – 5:06 | Why GLP-1s became the entry point Bregman argues utilization broke conventional coverage for this class, calling GLP-1s the wildfires and hurricanes of pharmacy, and says the carve-outs being built for them are scaffolding for other drugs.

5:06 – 6:15 | From prescription to doorstep Patients keep their own physician, the script goes to Andel's non-dispensing pharmacy over Surescripts, and eligibility, payment and shipping run automatically. No telehealth requirement, no limited network.

6:15 – 7:26 | Where the treating physician fits Bregman's case that the model re-empowers the prescriber, and his argument that the administrative layer it removes was never adding clinical value.

7:26 – 8:16 | Does anything change at the point of prescribing Andel built its own pharmacy, NPI and Surescripts integration so it appears in any EMR. By Bregman's account, a physician sends the script exactly as they would to any retail pharmacy.

8:16 – 9:07 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

9:07 – 10:06 | Does the fill land in the chart Because the order travels through Surescripts, it reports back like any other prescription. Bregman says a free data exchange API also lets plans reconcile out-of-pocket spending and accumulators, which he frames as the dividing line from direct-to-consumer channels.

10:06 – 11:20 | Cost and experience versus the pharmacy benefit Bregman claims fewer than 2% of members get access even when a plan covers GLP-1s, and argues a predictable monthly out-of-pocket beats an approval that may not hold next year.

11:20 – 12:49 | What happens when the job ends The access cliff. Bregman says COBRA may let some plans continue the benefit and that portability between employers is on the roadmap, but acknowledges that for certain drugs the negotiated price disappears once the employer contribution stops.

12:49 – 13:42 | Where Medicare fits None of Andel's products are designed for Medicare. Bregman points to the commercial market as the company's focus and to the patients government programs don't reach.

13:42 – 14:37 | What Bregman wants physicians to know His pitch to prescribers: the platform treats the prescriber's decision as final and doesn't challenge it with prior authorization or utilization management.

14:37 – 15:19 | Beyond GLP-1s Bregman says the first non-GLP-1 agreement is signed and more drugs are expected on the platform within six months, and asks prescribers for direct feedback.

15:19 – 16:47 | Closing thoughts and outro Littrell thanks Bregman and wraps the episode.

S1 Ep176: Cutting the PBM out of your patient's GLP-1, with Jay Bregman of Andel

Off the Chart: A Business of Medicine Podcast

S1 Ep176: Cutting the PBM out of your patient's GLP-1, with Jay Bregman of Andel