AXS26: How Andel's Direct-to-Employer Model Is Expanding GLP-1 Access Without Traditional Insurance

In an interview with Pharmacy Times at Asembia’s AXS26 Summit, Jay Bregman, founder and CEO of Andel, explained how his company's partnership with Eli Lilly's "Employer Connect" program creates a more flexible, cost-effective alternative to traditional insurance for glucagon-like peptide-1 (GLP-1) access, enabling employers to contribute anywhere from $100 per fill to full coverage on a month-to-month basis. Bregman emphasized that Andel operates as a patient- and provider-first pharmacy—processing prescriptions directly from doctors' electronic medical records (EMRs) without prior authorization or utilization management interference—and expressed excitement about the emerging oral GLP-1 options that will expand treatment choices. Bregman also described Andel's streamlined fulfillment technology, which consolidates 5 or 6 traditionally separate entities into a single integrated platform, and noted that growing interest from pharma companies beyond Lilly is driving the company's expansion strategy.

Pharmacy Times: Can you introduce yourself and explain your current role?

Jay Bregman: Hi, I'm Jay Bregman. I'm the founder and CEO of Andel.

Pharmacy Times: How does Andel's partnership with Eli Lilly's "Employer Connect" program specifically remove the traditional insurance barriers that have previously blocked GLP-1 access?

Bregman: Essentially, what we're able to do with this program is obtain access to the medications for use in our marketplace under different conditions than would traditionally be offered and, therefore, at a different, more favorable pricing structure. Employees who might not want to use traditional insurance to access the medication—because that would lock them into a more rigid platform of having to cover the medication for longer periods of time or with greater financial risk to themselves—might want a more flexible solution, like the one that Andel is able to offer using these Lilly medications. This allows employers to have a flexible, even month-to-month contribution of as little as $100 per fill all the way up to 100%, depending on what they choose. That contribution could actually increase dynamically in subsequent months, or even increase based on behaviors. For example, if you wanted to increase the contribution based on members who were stepping on a scale every day for a month, you could do things like that—things that just wouldn't be possible within the constraints of modern insurance.

Pharmacy Times: You advocate for starting patients on injectables and moving them to pills once stable—what are the specific cost and adherence advantages of this "step-down" approach for the employer?

Bregman: I would say that we don't advocate for anything. We're a pharmacy, so we ultimately are ingesting the prescriptions from the provider. We really believe that the doctor, the nurse practitioner, or another provider on our end, employee, or member knows best, so we'll process whatever comes to them. That's another benefit of Andel vs traditional insurance. Traditional insurance likes to meddle—it likes to get into prior authorization, utilization management, and other things that are really not about what's best for the patient clinically but what's best ultimately for the insurer financially. We believe that the patient should have a choice and the provider should have a choice. We are extremely excited about the oral medications because they're going to give our providers and the patients on our network more options to address whatever specific course of treatment their provider has in mind.

Pharmacy Times: Why should GLP-1s be viewed as long-term preventive medications, similar to statins, rather than short-term interventions?

Bregman: The data are very clear: the benefits simply disappear when you stop. My understanding is that if you take a statin for a short period of time and stop, the benefits are not going to accrue very much either—it's a chronic condition. Both of them address chronic conditions. Statins are addressing cardiovascular disease, which is clearly a chronic condition. GLP-1s are addressing obesity, sleep apnea, and many other chronic conditions. It seems almost illogical to think that for a chronic condition, you could simply take a pill or an injectable and then everything would be fine. We see this in mental health and many other areas where chronic conditions require some degree of medication for a long time, or even forever, and what's wrong with that? People seem to have this view that humans are perfect and 100% adapted to our environment, and I think that's just not true. We've evolved our environment, and our technology has evolved far faster than our bodies have adapted. So it shouldn't be any question that, in this day and age, people may need to take medications for a variety of different conditions to best enjoy a healthy and happy life—and I think that's a great thing.

Pharmacy Times: Affordability is the top concern for payers. How does the Direct-to-Employer (DTE) model provide a more sustainable financial path than the traditional pharmacy benefit manager (PBM)–led model?

Bregman: I think it's complementary. We are now starting to prospect with payers and health plans, and I think health plans, like everyone else, have been hit by the issue that GLP-1 coverage for weight loss is fundamentally incompatible with a traditional insurance-based system. What we're able to do uniquely is partner with an existing PBM, take some of the medications off of the traditional plan, route them through our own platform, and get access to the drugs through Lilly—and soon many other pharma companies. This provides a much better financial arrangement for the payer on these particular drugs, and it also creates a better financial outcome for the pharma manufacturer. Really, everybody wins—except maybe the insurance company, but I think everybody can deal with that. The bottom line is that we are able to build a parallel pathway with a PBM without being disruptive or displacing them, and that's what makes this such a powerful solution for payers.

Pharmacy Times: Now that the Andel platform is live, how does it physically streamline the fulfillment of GLP-1s to meet the surging demand from these DTE programs?

Bregman: We invested very heavily in our technology. We created a nondispensing pharmacy, so all prescriptions in our program come directly from doctors' EMRs to our system. Right now, any provider in the country can write a prescription to the Andel pharmacy, and it comes directly into our system. We match it with an eligibility file from our employer clients, then verify the member. The member then downloads our app—available on the App Store and the Play Store—and pays for the medication net of the employer contribution. It then ships out the next day via UPS, absolutely seamlessly. What we've created is a system where, normally, 5 or 6 separate entities would be doing what I just described. We do it all ourselves, with partners we're tightly integrated with on a technological basis. That allows us to provide a truly superior and scalable customer experience.

Pharmacy Times: Is there anything you would like to add?

Bregman: In case anybody is wondering why we're going to Asembia—because it is a specialty conference for pharma—it's because, on the back of the Lilly announcement, there has been a huge groundswell of new interest from pharma companies other than Lilly about whether the direct-to-employer model could work for them and their drugs as well. We're going there to explore that interest.