New 'Carve-Out' Model Tackles Soaring Cost of Obesity Drugs

LAKELAND, Fla. – January 12, 2026 – In a move aimed at navigating the turbulent waters of prescription drug costs, digital pharmacy HealthDyne announced today it will support new access solutions for employers seeking to cover popular FDA-approved obesity medications from Eli Lilly and Company. The collaboration introduces a 'carve-out' benefit option, a model designed to give employers a more sustainable path to offering treatments that many have been forced to abandon due to soaring costs.

HealthDyne will serve as a dispensing pharmacy, working with digital health providers to create an integrated program that separates obesity drug benefits from a company's primary health plan. The initiative comes as a surge in demand for highly effective GLP-1 drugs like Lilly's Zepbound has created a significant financial dilemma for employers, pitting employee health goals against unsustainable budget pressures.

The Employer's Dilemma Over High-Cost Drugs

The market for anti-obesity medications has exploded, with some analysts projecting it could exceed $100 billion by the next decade. This growth is fueled by a new class of drugs that have demonstrated significant weight loss results. However, with monthly costs often exceeding $1,000 per patient, the financial impact on employer-sponsored health plans has been immediate and severe. Recent data shows that spending on these drugs contributed to an 8.4% jump in employer pharmacy benefit costs over the past year.

This has led to a fractured landscape of coverage. While a 2025 survey from KFF found that 43% of very large firms now cover GLP-1 drugs for weight loss, many smaller companies and even some large health systems have been forced to pull back. Citing budget overruns and concerns about long-term adherence, some employers have dropped coverage entirely or implemented strict restrictions, leaving employees who have been prescribed the medications in a lurch.

"We have witnessed a significant shift in the demand for obesity management medications, requiring more sustainable models," said Steve Saft, CEO of HealthDyne, in the company's announcement. "With the current approach, coverage is shrinking and patients are left without options."

How 'Carve-Out' Benefits Offer a Lifeline

The model proposed by HealthDyne and Lilly is not new, but its application to the obesity drug crisis is a novel strategy. A 'carve-out' benefit works by separating a specific, high-cost area of healthcare—in this case, obesity management drugs—from an employer's general health insurance plan. The employer then contracts directly with a specialized vendor, like a digital pharmacy or pharmacy benefit manager (PBM), to manage that specific benefit.

This approach offers several key advantages for employers grappling with high costs. It provides greater transparency into drug spending, allowing companies to see exactly where their money is going, which is often difficult in bundled insurance packages. This visibility enables more precise cost control, customized plan designs, and direct negotiation on rebates and pricing. Historically, carve-outs have been used to manage other complex and expensive areas, such as mental health services, organ transplants, and specialty pharmacy for other conditions.

However, the model is not without potential drawbacks. Managing multiple vendors can increase the administrative burden on HR departments, and there is a risk of creating a fragmented experience for employees, who may have to navigate different systems and contact points for their medical and pharmacy needs. Effective coordination and clear communication are critical to avoiding patient confusion and ensuring seamless care.

A New Digital Pharmacy and Big Pharma Alliance

HealthDyne and Lilly's solution aims to mitigate these challenges by creating an integrated ecosystem. By combining Lilly's medications with HealthDyne's technology platform, the partners intend to offer a streamlined experience that connects the patient, provider, and pharmacy in a single, managed journey.

"Employers continue to tell us they want to better support their employees' health but face real challenges in providing coverage for obesity management medicines," said Kevin Hern, Senior Vice President of Lilly Employer at Lilly USA. "We're excited to work with organizations that share our commitment to removing friction and providing flexible, transparent solutions for employers to help expand access to obesity management medicines for people who need them."

HealthDyne asserts that its technology is the key differentiator. The company highlights its URAC-accredited pharmacy operations and a system built on an "AI-enabled intake" process, real-time reporting for employers, and "high-touch clinical engagement" for patients. The goal is to ensure that access is clinically appropriate while delivering the cost-efficiency and scalability that employers need.

"Our technology stack and patient care model set us apart," Saft added. "It's not just about filling prescriptions. It's about creating a connected, patient-first journey."

A Broader Strategy for Medication Access

This partnership represents one piece of a much larger, industry-wide effort to solve the access and affordability puzzle for a new generation of blockbuster drugs. For Eli Lilly, it complements other initiatives like its LillyDirect platform, a direct-to-consumer website that allows patients to obtain Zepbound through telehealth consultations and home delivery, sometimes at a lower cash price than the list price. These multi-pronged strategies signal a recognition by pharmaceutical manufacturers that traditional insurance pathways are insufficient to meet the current demand.

This carve-out model provides an on-ramp for employers who currently do not cover these medicines at all, offering a controlled, flexible entry point rather than an all-or-nothing commitment. As the market continues to evolve, such innovative alliances between pharmaceutical giants and agile digital health companies may become a standard template for managing the next wave of high-cost, high-demand therapies, reshaping the landscape of employer-sponsored benefits for years to come.