✦ Specialty Care Accounts

Predictable Specialty Care Costs. Meaningful Employee Support.

Give employees more flexibility to access eligible specialty care while helping employers manage GLP-1, HRT, and other high-cost healthcare expenses through a fixed, configurable allowance.

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GLP-1 Refill Approved Paid from Specialty Care Account
LSA
Telehealth Visit Paid Weight management consult
Health
Icon GLP-1 Medication
Icon Hormone Therapy
Icon Therapy Sessions
Icon Nutrition Counseling
$1,240.00
Specialty Care Balance
Why It Matters

Why Employers Are Rethinking How GLP-1 Care Is Funded

As demand for GLP-1s and specialty care grows, employers need more predictable ways to manage costs while supporting employee choice and access.

  • Cost Control: Set defined allowances to help manage specialty care spending.
  • Predictable Budgets: Establish clear funding limits without open-ended allowance costs.
  • Flexible Access: Support eligible care through digital, retail, and in-person providers.
  • Built to Adapt: Extend support to additional specialty care categories as needs evolve.
The Challenge

Rising Specialty Care Costs Are Challenging Employer Budgets

Growing demand for GLP-1 medications and other specialty treatments is creating new cost pressures for employers. Traditional benefit models can make spending difficult to predict, leaving organizations searching for more flexible, sustainable ways to support employee needs.

Alternative way to cover GLP-1s and reduce spend

Specialty Care Accounts offer a configurable way to support eligible treatments with defined employer funding, complementing existing healthcare benefits.

Two Approaches

From Unpredictable Costs to a Cost Containment Strategy

Replace open-ended allowance spending with employer-defined specialty care funding that supports employee choice and more predictable costs.

Traditional Cost Challenges

  • Renewal pressure: high-cost categories in the medical plan drive unsustainable increases
  • Rising demand for GLP-1s and specialty care strains traditional benefit models
  • High out-of-pocket costs lead 59% of employees to delay care

With Specialty Care Accounts

  • A fixed annual allowance you define
  • Predictable, capped healthcare spend
  • Expanded access to the care employees are seeking
  • Reduce spend if you already cover GLP-1s
  • Respond to demand without open-ended costs if you don’t

Beyond GLP-1s

Flexible Support Beyond GLP-1s

Specialty Care Accounts give employers a configurable way to support a range of eligible healthcare needs—from weight management and hormone therapy to specialized mental health services—all within a defined budget.

GLP-1s & Weight Management

Fund GLP-1 prescriptions, telehealth visits, and the nutrition counseling support that goes with them.

Hormone Therapy & Menopause Care

Support HRT and menopause care that often falls outside traditional coverage—compliantly, within a fixed budget.

Specialty Mental Health

Extend the same capped model to specialty mental health and out-of-pocket care as needs evolve.

How It Works

How Specialty Care Accounts Work

A flexible, employer-funded approach to specialty care that works alongside existing health plans and Lifestyle Spending Accounts.

1

Define Your Budget

Employers set a fixed annual specialty care budget and define eligible expenses.

2

Give Employees Choice

Employees use funds for eligible specialty drugs and services, including GLP-1s, HRT, and weight management.

3

Complement Existing Benefits

Programs work alongside existing health plans and Lifestyle Spending Accounts (LSA).

4

Maintain Cost Predictability

Employer healthcare spend remains capped, predictable, and transparent.

In Practice

A Year With a Specialty Care Account

See how an employer-funded Specialty Care Account can support an employee's weight management journey while keeping program spending predictable.

Jessica, 41 — Weight Management Journey

Illustrative persona, not a real customer

January
Her employer funds an annual Specialty Care Account with a defined allowance.
February
She books a GLP-1 telehealth consult, and the visit is approved as an eligible specialty expense.
March
Her monthly GLP-1 prescription is paid directly from her Specialty Care Account balance.
June
She adds nutrition counseling to support her progress—another eligible expense, no claim forms.
December
Her employer's account funding remains within its defined annual budget.
Scenario is illustrative, written to show how a Specialty Care Account can be configured. Allowance amounts are set by each employer.

Take Control of Specialty Care Spending

Protect budgets from GLP-1 renewal shock while expanding access to the care employees are seeking. Learn how to shift from open-ended formulary coverage to a predictable, capped model that future-proofs your benefits strategy.

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