What a broker should ask before recommending a GLP-1 carve out
Upgrades Health · July 29, 2026 · 6 minute read
Every broker serving the mid market is getting the same question this year: what do we do about GLP-1s? The carve out answer is gaining ground for good reasons. It is also the kind of recommendation that attaches your name to a vendor for years. Before you make it, get real answers to nine questions.
The sourcing questions
1. Where does the medication come from, exactly?
Not a category answer. A chain of custody answer. Which licensed pharmacies, under what arrangements, with what documentation. A program that answers this with marketing language instead of paperwork is telling you something. The bottom of this market runs on sourcing nobody can trace, and your recommendation is only as good as the weakest link in that chain.
2. Which licensed U.S. pharmacy fills every product?
Ask it exactly that way, and get the licenses in writing. Some programs blur where their products actually come from. If a vendor can’t name the licensed U.S. pharmacy behind every fill, you are not looking at a pharmacy benefit. You are looking at a liability with a login page.
The clinical questions
3. Who evaluates the employee before the first prescription?
A licensed clinician should make an individual determination before anything is prescribed. If eligibility is a questionnaire that approves nearly everyone, the evaluation is theater. Ask what share of applicants the clinical process declines, and ask what happens to those people.
4. What happens after the first fill?
This is the question that separates programs. GLP-1 therapy involves dose changes, side effect management, and decisions about continuing, pausing, or stopping. Somebody has to own those decisions for as long as the employee is on therapy. If monitoring is an optional add on from a third party, ask who is accountable when the employee falls between the two vendors. Write the answer down, because you will need it later if things go wrong.
5. Can the program describe its clinical standard in one page?
A real clinical operation can tell you what it monitors, how often, and what triggers an intervention. If the answer is a brand deck instead of a protocol summary, keep asking until you get the protocol summary or conclude there is not one.
The money questions
6. What is the all in monthly price per member, and what sits inside it?
One number, fixed, in the contract. Then ask what is not in it: dispensing fees, clinical fees, platform fees, shipping. A program that quotes a clean headline price and recovers margin through fees is running the same spread game the carve out was supposed to escape.
7. Who keeps the rebates and the spread?
The honest answers are either nobody, because the pricing model does not generate them, or a named party with a disclosed amount. Any answer that requires a diagram with more than three boxes deserves suspicion.
The accountability questions
8. What does the exit look like?
Term length, termination rights, and what happens to employees mid therapy if the employer leaves. Continuity of care during an offboarding is the detail nobody negotiates and everybody eventually needs. A confident program has an answer prepared. An evasive one is planning to make leaving painful.
9. Where does the liability actually sit?
Read the indemnification language, not the sales material. If the clinical entity, the sourcing entity, and the platform entity are three different companies, understand which one stands behind what. You are not just recommending a price. You are recommending a structure, and structures fail at their seams.
A good program answers all nine in writing without flinching. A bad one answers six and changes the subject three times.
What this list is really for
None of these questions is exotic. They are the same diligence you would run on any vendor holding your client's money and your client's employees' health. The reason to ask them systematically is that GLP-1 programs are new enough that polish and substance have not yet separated in the market. The questions do the separating for you.
We built our program to answer all nine in writing, and we think every program in this category should have to. If you are evaluating options for a client, start the conversation on the brokers page and ask us the hard ones first.
