Q&A: Cutting Through Cost and Misinformation in GLP-1 Therapy

In this interview with Pharmacy Times, Ferrin Williams, PharmD, MBA, chief pharmacy officer at Scripta Insights, discusses how pharmacists can play a central role in improving access, affordability, and long-term success with glucagon-like peptide-1 (GLP-1) receptor agonists. Williams outlines practical strategies for insurance optimization, cash-pay pathways, prior authorizations, and safe medication switching. She emphasizes the pharmacist’s role in combating misinformation, setting realistic patient expectations, and supporting adherence through education and follow-up. Looking ahead, Williams positions pharmacists as critical navigators, safety coaches, and data-informed partners in GLP-1 care.

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

Ferrin Williams, PharmD, MBA: I'm Ferrin Williams. I'm the chief pharmacy officer here at Scripta Insights. We help patients find the right medication at the best price. My background was 10 years in retail pharmacy at a big chain. Then I spent a few years at a startup PBM, followed by a few years in consulting, before joining Scripta 3 years ago.

Pharmacy Times: From a cost perspective, what strategies can pharmacists use to help patients lower their out-of-pocket spend on GLP-1 medications—both through insurance optimization and cash-pay alternatives?

Williams: Start by figuring out which lane the patient is in, because the best strategy depends on whether or not the patient has insurance coverage. There are 6 things to kind of think about if they do have insurance.

1. Confirm the exact indication that is being billed. Many plans cover diabetes GLP-1s more reliably than obesity GLP-1s, and make sure that diagnosis codes, BMI, documentation, and comorbidities such as hypertension, dyslipidemia, and prediabetes are captured when appropriate and truthful.
2. Work the formulary like a playbook. Check preferred products, step therapy requirements, quantity limits, and whether the plan prefers one strength or drug over another. If the plan prefers an agent, switching to the preferred option can cut out-of-pocket costs dramatically.
3. Provide prior authorization support that actually helps your patient. Give prescribers a simple checklist—baseline weight, BMI, prior weight loss attempts, relevant labs, contraindications, and documented response or tolerability to prior agents. Missing documentation is a common reason for delays and denials.
4. Use the right fill structure. Ask the patient’s PBM about 30- versus 90-day fills, mail order requirements, and whether the plan has a different copay tier at a preferred pharmacy network.
5. Check deductible and accumulator rules early. If the patient is in January or February deductible season, set expectations that the first fill may be high even with coverage. Also confirm whether manufacturer assistance counts toward their deductible, because these are not specialty medications and most PBMs won’t have visibility into manufacturer assistance being applied.
6. If it is denied, appeal intelligently. Denials often hinge on technicalities such as missing BMI, missing tried-and-failed attempts, or incorrect diagnosis. Help the patient and prescriber resubmit with the exact requirement addressed.

If the patient is using cash pay or alternative pathways—maybe they don’t have coverage, or even with coverage it’s still unaffordable—there are 4 things to keep in mind.

1. Be transparent and clear with your patient about what cash pay really means. Cash price varies widely by pharmacy discount program, dosage form, and sometimes by NDC and packaging. A quick price check across multiple options can really matter.
2. Consider manufacturer programs when eligible. Some savings programs do exist, but eligibility and plan restrictions are common. Pharmacists can help patients by screening eligibility and preventing false hope.
3. Discuss therapeutic alternatives when clinically appropriate. For some patients, other weight management medications or intensive lifestyle programs may provide meaningful benefit while access issues are being resolved.
4. Address compounding and NDCs from companies providing the active ingredient combined with ingredients like vitamin B12 carefully and ethically. Confirm your patient understands quality variability and only use reputable, appropriately licensed sources.

Key phrasing you can use for patients is something like, “My goal is to help you pay the lowest safe price, but first we have to confirm what your plan will actually cover and what documentation it requires.”

Pharmacy Times: As more patients transition between GLP-1 therapies, what are the most important considerations pharmacists should keep in mind to support a safe and seamless medication switch?

Williams: Medication switches are common due to tolerability, supply issues, coverage changes, or clinical goals. Here at Scripta Insights, we help patients find the right medication at the best price, most often by identifying safe, clinically appropriate switches that lower out-of-pocket cost. Pharmacists can help make the transition smoother by focusing on a few essentials.

1. Clarify the reason for the switch. Intolerance versus lack of response versus access and supply issues versus cost or unaffordability determines the plan, dose timing, titration speed, and counseling.
2. Avoid overlap and gaps. Confirm the last dose date and when the new agent should start.
3. For GLP-1s specifically, pharmacists should treat it like a new start in many cases. Even if a patient did fine on one GLP-1, the next agent can have different potency and GI effects. Conservative titration is usually safer than trying to match doses.
4. Watch high-risk medications and conditions. GLP-1s can change appetite and intake, which can affect hypoglycemia risk with insulin or sulfonylureas. Coordinate dose reductions with prescribers when needed.
5. Review contraindications and red flags at every switch. This includes a history of pancreatitis, gallbladder disease symptoms, severe GI disease, pregnancy considerations, and thyroid cancer warnings where applicable.
6. Provide standardized counseling on administration, storage, injection technique, missed-dose rules, and how to manage nausea and constipation, which are frequent failure points.
7. Document and monitor. Encourage patients to track weight trends, GI symptoms, hydration, and, if diabetic, glucose patterns, especially during the 4 to 8 weeks post-switch.

Pharmacy Times: GLP-1 misinformation is widespread on social media. How can pharmacists help patients distinguish evidence-based guidance from wellness hype?

Williams: Pharmacists can be the myth filter without shaming patients for what they’ve heard online. A practical approach is to start by asking what they’ve seen, what they heard, and what worries them. This invites honesty and lets you target the specific myth.

I like to think of an acronym called SEC for 3 quick credibility checks. I have to give a quick shout out to the number one team in the SEC—Boomer Sooners—for any fans out there. Go Sooners.

SEC stands for source, evidence, and claims.

• Source asks whether this is a licensed clinician or a product seller or influencer.
• Evidence asks whether they’re citing peer-reviewed studies or just testimonials.
• Claims look at whether the language sounds absolute, such as “no side effects,” “melts fat,” or “detoxes hormones,” which is almost always hype.

Reframe with what we do know. These medications can be highly effective for many patients, but they are not magic and results to vary. Side effects are common and manageable for most people, but severe symptoms require medical evaluation. Long-term success often depends on sustained therapy plus nutrition, protein, activity, and follow-up care. Lastly, provide a “bring it to me” invitation. If you see a claim online, send it to me and I’ll help you check it out.

Pharmacy Times: What trusted resources or educational tools do you recommend pharmacists share with patients who are starting or currently using GLP-1 medications?

Williams: As always, select resources that are credible, readable, and easy to access when creating patient materials. You can use FDA medication guides and official prescribing information for safety, black box warnings, and dose rules.

You can also use professional society patient pages, such as the American Diabetes Association for diabetes-related GLP-1 education, and CDC and NIH pages on obesity, diabetes prevention, and weight management for foundational counseling. These are good resources clinicians can use to create readable materials for patients.

One thing to keep in mind with FDA medication guides is to use clinical judgment to fill in gaps patients may miss. For example, when Novo Nordisk received FDA approval for the Wegovy pill, it did not publish a separate side effect table from the injectable and instead referred to injectable data noting similar adverse reactions. Pharmacists can help patients understand that inference using clinical judgment and experience.

There are also resources you can send patients directly or print, such as Mayo Clinic and Cleveland Clinic materials, and patient-friendly guides in clinical pharmacology tools. You can create your own one-pagers, such as what to expect in weeks one through eight, managing nausea and constipation, injection tips, missed-dose rules, or when to call the doctor.

Don’t forget that face-to-face counseling is still important. Patients often throw away papers included with prescriptions, so whenever possible, provide that in-person education.

Pharmacy Times: How can pharmacists proactively set expectations around adherence, side effects, and long-term use to help patients achieve sustainable outcomes with GLP-1 therapy?

Williams: This is a really important question. The best outcomes come from proactive expectation setting before the first dose.

1. Normalize common side effects without minimizing them. Most people experience GI symptoms early. We can usually manage them, but patients shouldn’t suffer in silence.
2. Give concrete mitigation tips—smaller meals, slower eating, prioritizing protein, avoiding high-fat meals early, hydration, a fiber plan, considering over-the-counter constipation support when appropriate, and stopping eating at the first sign of fullness.
3. Emphasize that dose escalation is optional, not a race. The right dose is the lowest dose that’s effective and tolerable.
4. Define what success looks like beyond the scale. Improvements in A1C, blood pressure, mobility, and cravings are meaningful wins.
5. Talk honestly about long-term therapy. Many patients regain weight when they stop. Reframe it like other chronic conditions—if it’s working and tolerated, long-term treatment is common.
6. Build a follow-up cadence. Suggest check-ins after the first dose, after titration steps, and especially at eight to 12 weeks to assess response, tolerability, and affordability.

Pharmacy Times: Looking ahead, what role do you see pharmacists playing in helping patients balance affordability, access, and long-term success with GLP-1 treatments?

Williams: Pharmacists are becoming the operational glue in GLP-1 care. At Scripta, our pharmacists focus on 3 areas.

1. Access navigation: Pharmacists help patients move through formulary rules, prior authorizations, plan changes, and shortages with fewer delays.
2. Equity advocacy: Pharmacists help patients find realistic alternatives when cost is prohibitive, without judgment, and reduce start-stop cycles that can hurt outcomes.
3. Being a data-informed partner: Tracking patterns like abandonment due to cost, intolerability, titration issues, and denials, and feeding that data back to prescribers and health systems to improve processes.

Community pharmacists also play 2 critical roles: the safety coach, ensuring correct administration, managing side effects, spotting red flags early, and preventing misinformation-driven decisions; and the therapy optimizer, supporting safe switching, coordinating dose adjustments with prescribers, especially with insulin and sulfonylureas, and monitoring adherence barriers.