The mechanics, start to finish
No mystery and no magic. The program is a structural change to where one drug category lives in your benefit stack, with a clinical operation running inside it.
Let’s talk
Six design decisions that define the program
- 1. The carve out
- Weight management GLP-1s move out of the carrier pharmacy formulary. Everything else in your medical and pharmacy benefit stays untouched. The carve out is a plan design change your carrier processes at renewal or midyear, depending on the contract.
- 2. Direct structure
- The category runs through an employer directed program instead of a conventional PBM arrangement, so no intermediary sits between the plan and the pharmacy taking a spread on each fill.
- 3. Fixed monthly pricing
- One fixed monthly price per member, the same at every dose. No spread, no markup, no service fee, no percentage of anything. The specific price depends on plan design and is quoted in writing during evaluation.
- 4. Member cost design
- You choose the employee share, and most employers choose low or zero cost at the point of sale. The medication should not be a monthly negotiation with a deductible.
- 5. The clinical layer
- A licensed clinician evaluates every employee before any prescription, then provides scheduled monitoring and dose management for the life of the therapy. This layer is the program's core, included in the base structure.
- 6. The term
- Twelve month initial term, no early termination penalty. Offboarding includes planned continuity of care for members mid therapy.
What happens around every prescription
Enrollment starts with an individual evaluation by a licensed clinician: health history, current medications, contraindications, and a conversation about goals and expectations. Not every applicant is approved, because the evaluation is real.
On therapy, monitoring runs on a protocol. Scheduled check ins, side effect management in the early months when it matters most, dose adjustments made with context, and a defined escalation path when something needs a closer look. When therapy should pause or end, the clinical team says so.
Employees reach their clinical team directly. Employers see program level reporting only, never individual health information.
From signature to first fill in 45 to 60 days
Built to run without a project team on your side. Your HR lead approves things. We do things.
- Weeks 1 and 2Plan review and carve out coordination
We review your current pharmacy arrangement with your broker, prepare the carve out language, and coordinate the formulary change with your carrier.
- Weeks 3 and 4Program setup
Contribution design is finalized, eligibility rules are configured, and the monthly member pricing is locked in writing.
- Weeks 5 and 6Enrollment and communication
Employees get clear enrollment materials written for people, not plan documents. Clinical evaluations begin as enrollments arrive.
- Weeks 7 and 8Launch
First fills reach members. Monitoring schedules start. Your team gets program level reporting and a named contact instead of a ticket portal.
Standards that do not move
U.S.-licensed sourcing only
Compounded by state-licensed U.S. pharmacies for each member. No research chemicals, no marketplace sourcing. If it isn't from a state-licensed U.S. pharmacy, it isn't in the program.
Licensed and documented
Licensed clinicians on every prescription. Licensed pharmacies with documented sourcing on every fill. The paper trail exists and holds up.
Accountable by design
One program owns evaluation, sourcing, monitoring, and the standard of care. When you ask who is responsible, the answer is one name, in the contract.
Live in
60 days
or fewer.
Your HR team approves two things. We handle the rest, with no open enrollment dependency.
Not projections.
Commitments.
Every number here is something we control and write into the agreement.
Clinician, every prescription
A licensed clinician evaluates each member before anything is prescribed.
Service fee
No platform, admin or setup fee. No PBM spread, no markup.
Or fewer to launch
From signature to first fill, handled by us.
U.S.-based
Licensed U.S. clinicians and state-licensed U.S. pharmacies.
Care that keeps going
after the first fill.
You’re offering a benefit, not practicing medicine. Every clinical decision sits with a licensed clinician inside one accountable program, from the first evaluation to the day therapy ends.
Health history, medications, contraindications. The program is willing to say no.
State-licensed U.S. pharmacy, documented chain of custody, low or zero cost to the member.
Side effects are most common early. That’s when the clinical team is closest.
Adjustments made with context by people who know the patient.
Scheduled, protocol driven, for as long as therapy runs. Including when it should stop.
Employers see program level reporting only. Individual health information stays between the member and the clinical team.
What your employees
actually see.
You fund it. You never see who uses it. Here’s the member side, start to finish.
- 01A real evaluation
A licensed clinician reviews their history first. The answer can be no.
- 02A care team that answers
Unlimited messaging with a team that has their chart.
- 03Little or nothing at checkout
Cost set by your coverage. Nothing at work singles anyone out.
The paperwork a real
program hands you.
All eight, in writing, before you sign.
- U.S.-based providers and pharmacies
- Licensed clinician on every prescription
- Licensed pharmacy dispensing
- Sourcing documentation
- Clinical protocol summary
- Fixed monthly pricing
- Indemnification language
- Program level reporting only
See the program before your renewal does the deciding.
Thirty minutes, your broker welcome in the room. Bring your current pharmacy numbers and we’ll show you exactly where the program fits.
- Pricing structure in writing, before you sign
- Clinical protocol summary and sourcing documentation
- Contract terms, including the exit
